METHOD FOR DESIGNING SURGICAL APPROACH FOR ADRENALECTOMY

摘要

FIELD: medicine.;SUBSTANCE: invention refers to medicine, namely to endocrine surgery and X-ray diagnostics, and can be used in treating patients with adrenal tumours when planning an adrenalectomy approach. Performing postprocessing of images in axial, frontal, sagittal planes, wherein for the right adrenal gland in three-dimensional visualization, the angle of vision is selected so that it corresponds to the position of the endoscope in laparoscopic right-sided, posterior retroperitoneoscopic, thoracophrenic approaches to the adrenal gland. Risk criteria are determined. For the right adrenal gland: BMI greater than or equal to 30 kg/m2; diameter of formation, greater than or equal to 8 cm; location of the adrenal gland with a tumour in the hilum of the kidney, relative to the inferior vena cava in the retrocaval position, as well as lower right hepatic vein; short central adrenal vein and its confluence into the posterior wall of the inferior vena cava; presence of adrenal accessory veins; presence of signs of vascular invasion. For the left adrenal gland: BMI, greater than or equal to 30 kg/m2, diameter of formation, greater than or equal to 8 cm; location of the adrenal gland with the tumour within the hilum of the kidney, the aortorenal vascular triangle, near the spleen vessels, as well as signs of vascular invasion of the tumour. Presence of each criterion is evaluated as 1 point and points are summed up. If the number is less than 3 points for the left adrenal gland and less than 4 points for the right adrenal gland, retroperitoneoscopic or laparoscopic approaches are considered preferable. If the number is more than 3 points for the left one and more than 4 points for the right one, an open adrenalectomy is considered to be preferable.;EFFECT: avoiding the development of intra- and postoperative complications, reducing the duration of the surgical intervention, minimization of surgical trauma and length of stay of patient in hospital due to creation of personal three-dimensional model of NP formation with nearest organs and vascular structures.;1 cl, 4 dwg, 1 ex