부신성 쿠싱씨 증후군 환자의 개복수술 후 합병증

초록

An adrenalectomy is needed in about 10 to 25% of Cushing's syndrome cases due to adrenal adenoma, hyperplasia, or carcinoma. The purpose of this study is to compare the postoperative complications of an adrenalectomy between Cushing's and non-Cushing's patients. Methods: Data were collected by reviewing the hospital charts of patients treated at Korea University from July 1987 to Jan. 1998 the clinical data were compared using statistical method. Results: An adrenalectomy was performed in 77 patients, and the causes of the adrenalectomy were primary aldosteronism (25 cases), pheochromocytoma (23 cases), Cushing's syndrome (20 cases), adrenal carcinoma (5 cases), non-functioning adrenal adenoma (2 cases), ganglioneuroma (1 case), and neuroblastoma (1 case). The causes of Cushing's syndrome were adenoma (16 cases), nodular hyperplasia (3 cases), and carcinoma (1 case). The types of adrenalectomy used were anterior (60 cases), posterior (14 cases), and lateral (3 cases). Postoperative complications were atelectasis, pneumonia, wound infection, paralytic ileus, intra-abdominal abscess, intra-abdominal bleeding, acute renal failure and psychosis, in order of frequency. The rate of post-operative complications in patients with Cushing's syndrome was 85%, which was higher than rate of 31.6% (p=0.02). Postoperative respiratory complications, such as atelectasis and pneumonias, were more common for patients with Cushing's syndrome (p=0.02). In patients of Cushing's syndrome, the development of postoperative complication was related to the length of the operation, the size of the tumor, the weight of the tumor, the site of the tumor, the pathology and the method of approach (p>0.05). Conclusion: The patients with Cushing's syndrome were prone to postoperative complications, and respiratory complications were the most common postoperative complication. Careful preoperative and postoperative respiratory management should reduce the complications of an adrenalectomy in patients with Cushing's syndrome.

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