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Abstract
The aim — evaluate the results of using the endovascular electrocoagulation occlusion of the adrenal vessels under Х-ray control approach in the treatment of adrenal tumors. Material and methods. In the Department of Combined Pathology and Retroperitoneal Surgery to analyze the effectiveness of perioperative
treatment regimen the study of the results of the multidisciplinary approach in 52 patients with the adrenal tumor for the period from 2015 to 2019 was conducted. In the study group, there were 6 (11.5%) patients with non-functioning tumors and 46 (88.5%) with hormone-producing tumors. Twenty-four hours after endovascular electrocoagulation occlusion of the adrenal vessels under Х-ray control, adrenalectomy was performed. Results. After endovascular
electrocoagulation occlusion of the adrenal vessels under Х-ray control, 49 laparoscopic adrenalectomy and three open-access adrenalectomy were performed. Using phlebography in 9 (17.3%) cases, variant adrenal venous anatomy was found. Among 52 patients, endovascular electrocoagulation occlusion of the adrenal arteries under Х-ray control in 49 (94.2%) cases were performed. In three (5.8%) cases, due to the impossibility of catheterization of small branches of the arteries of the adrenal gland, endovascular electrocoagulation occlusion of the adrenal vessels under Х-ray control was not performed. The duration of endovascular electrocoagulation occlusion of the adrenal vessels was in the range of 20-30 minutes. During the endovascular electrocoagulation occlusion of the adrenal vessels, the average level of the SBP was 135.9±8.1 mm Hg, heart rate 71.9±10.4 beats/min. One (1.9%) patient had an episode of the
short-term increase of BP (SBP 170 mm Hg, heart rate 96 beats/min). After endovascular electrocoagulation occlusion of the adrenal vessels, a subcapsular adrenal hematoma in one patient during LA was found, which did not cause any difficulties in performing the LA. In all other patients, with endovascular intervention no visual pathological changes there were associated. In patients with adrenal pheochromocytoma, the average levels of metanephrine in the urine of patients before and 24 hours after endovascular electrocoagulation occlusion of the adrenal vessels was 1075.6±794.3 μg/24h and 313.2±109.6 μg/24h. In patients with cortisol-secreting adrenal adenoma, the level of cortisol in the blood ranged from 438.6 to 658.0 nmol/l. The average level of cortisol in patients 24 hours after endovascular electrocoagulation occlusion of the adrenal vessels was 278.9±75.3 nmol/l. In patients with aldosteronesecreting adenoma, the level of aldosterone in the blood before and 24 hours after the endovascular electrocoagulation occlusion of the adrenal vessels it ranged from 243.9 to 637.2 ng/ml and 145.2-311.5 ng/ml. After endovascular electrocoagulation occlusion of the adrenal vessels, normalization of hormone levels was determined in 32 (69.6%) of 46 cases with functional tumors. Conclusions. The use of endovascular electrocoagulation occlusion of the adrenal vessels
under Х-ray control in the complex surgical treatment of adrenal tumors is a promising direction for the prevention of intraoperative hemodynamic disorders and bleeding.
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