adrenalectomy

adrenalectomy (vrukkakalumaayi bandhapetta laattin root addu "niyar/attu" + renal "+ greak"-ectomy "" outtu-cutting "; chilappol nadapadikramatthino falamaayundaakunna avasthaykko adks ennu ezhuthappedunnu) onno rando (ubhaykakshi) adrenal grandhikal neekkam cheiyunna shasthrakriyayaan. adhika hormonukal ulppaadippikkunnatho valuppathil valuppamullatho (2 inch allengil 4 muthal 5 centimeteril kooduthal) adrenal grandhikalude tumours neekkam cheyyaanaan ithu saadhaaranayaayi cheiyunnathu. adrenal grandhikalude arbuda tumour allengil vrukka allengil shwaasakosham polulla mattoru sthalathu ninnu padarnna cancer neekkam cheiyunnathinum adrenalectomy nadatthaam. kadinamaaya kogulopathiyullavarilo shasthrakriyaykk vidheyaraakkaan kazhiyaathavidham hridayavum shwaasakoshavum durbalamaayavarilo adrenalectomy nadathunnilla. oru thuranna murivu (laparotamy) allengil minimali invasive laparoscopic allengil robot assisted teknikkukal upayogichu nadapadikramam nadatthaam. ashupathriyil kuranja kaalayalav thaamasikkuka, kuranja raktha nashtam, samanamaaya sankeernathakal enniva kaaranam kuranja aakramanathmaka saankethikavidyakal paricharanatthinte swarnna nilavaaramaan.
oro vrukkaykkum mukalil oru adrenal grandhi sthithicheyyunnu. rund adrenal grandhikalum rakthasammardham, rakthathile panchasaarayude alavu, metabolism, rogaprathirodha sheshi, sammarddam, mattu avashya pravartthanangal enniva niyantrikkaan sahayikkunna hormonukal (steroid hormonukal, catecolamines) uthpaadippikkunnu. oru adrenal grandhi neekkam cheythaal, matte adrenal grandhi hormon uthppaadippikkunna punk ettedukkum. rund adrenal grandhikalum neekkam cheythaal, rogikk aajeevanantha steroid supplement aavasyamaanu.
soochanakal.
mikka adrenal tumourukalum kaansarillaatha (haanikaramallaatha) tumourukalaanu, mattu aarogya pravarthanangalkkaayi edutha sidi scan, emri allengil ultraasoundu polulla imajingiloode oru pindamayi palappozhum kaanapedunnu (aakasmikamaaya tumour kaanuka). eee adrenal pindangalkk vilayiruthal aavashyamaanenkilum, avayil bhooribhaagathinum (ekadesham 80 sathamaanam) adrenalectomy aavasyamilla. ennirunnaalum, adrenal grandhikalude hormon uthppaadippikkunna pravartthanam kaaranam, chila arbudarahita adrenal tumours aaldostiron (primery aldosteronism ennu vilikkunnu), courtisol (cushings disease allengil cushings syndrome ennu vilikkunnu), allengil catecolamines (pheochromositoma ennu vilikkunnu) thudangiya valareyadhikam hormonukal utppaadippikkaam. hormon uthppaadippikkunna eee tumorukalkku adrenalectomy aavashyamaayi vannekkaam. koodaathe, 4 centimeteril kooduthal valippamulla adrenal tumours hormonukal ulpaadippikkunnundo ennathu pariganikkathe, adrenal kaansarinulla saadhyatha vardhikkunnathinaal adrenalectomy aavasyamaanu. apoorvvamaayi (5-12%), adrenal tumour cancer (adrenocourtical carcinoma) aayirikkam, ithinu adrenalectomy aavasyamaanu. apoorvamaayi, vrukka allengil shwaasakosham polulla mattoru sthalathu ninnu padarunna oru metaastaattik cancer aayirikkam pindam. metaastaasis adrenal grandhiyilekku verthirichuvekkukayaanel, athu adrenalectomic oru sthaanaarthiyaayirikkaam.
ethirvashangal.
shasthrakriyaykk saadhaaranayaayi anuyojyamallaatha rogikalaanu adrenalectomic (oru saahacharyathilum sasthrakriya cheyyathirikkaanulla oru kaaranam) oru samboornna ethirppu sasthrakriya ulppaadippikkunna sareerathinu sammarddam kaaranam kadinamaaya kogulopathy mosham cardiopulmonary prakadanavum ullavaraan. koodaathe, american association oof klinikkal endocrinologistukalum american association oof endocrine sarjans maarganirddeshangalum parayunnath, valia pindatthinu chuttum kaikaaryam cheiyunnathile budhimuttukal kaaranam valia tumour valuppamullappol (6 centimeteril kooduthal) minimali-invasive teknikkukal ozhivaakkanam, koodaathe cancer tissue poornnamaayum neekkam cheyyaatha adrenocourtical carsinomayil. ennirunnaalum, 898 rogikalude oru mettaa vishakalanathil kuranja aakramanathmaka saankethikavidyakal upayogichu valia (> 5 centimeter) tumourukalil polum kuranja dairkhyamulla thamasam, kuranja raktha nashtam, uyarnna sankeernathakal enniva kandethiyittundu.
saankethikavidyakal.
adrenalectomiculla saankethikavidyakale pradhaanamaayum rund tharangalayi thirichirikkunnu ooppan sarjikkal laparotamy vezhsas minimali invasive teknikkukal.
ooppan sarjari.
cancer tissue poornnamaayum neekkam cheyyaatha apakadasaadyathayulla valia (6 centimeteril kooduthal) cancer tumourukalkkaayi sarjanmaar saadhaaranayaayi ooppan sarjari reserve cheiyunnu. parambaraagatha upakaranangalum murivukalum (murivukal) upayogichu avar ooppan sarjari nadathunnu.
ettavum kuranja aakramanathmaka saankethikavidyakal.
shasthrakriyayude oru valuppamulla, 3D kazhcha nalkunna oru cheria camera vazhi sasthrakriya drishyavalkkarikkunna samayat sarjanu avarude kaikal upayogichu sasthrakriya upakaranangal nerittu niyantrikkaan anuvadikkunnathinu niravadhi cheria murivukal (murivukal) cheiyunna laparoscopic kuranja aakramanathmaka saankethikavidyakalaayirikkam. laparoscopic shasthrakriyaykk niravadhi gunangalundu. udaaharanathinu, eee shasthrakriyaykk cheria paadukal, kuranja vedana, kuranja raktha nashtam, samanamaaya sankeernnatha nirakk, parambaraagatha ooppan sarjarikk pakaram kuranja veendedukkal kaalayalav ennivayundu. parambaraagathamaayi, ithu laparoscopic transperitonial sameepanathiloodeyaanu (ell. tii. eiii), avide vayattil cheria murivukal undaakki perittoniyatthiloode adrenal grandhikalil athicherunnu.
ennirunnaalum, retroperitonoscope adrenalectomy (praa) ennu vilikkunna oru badal sameepanam saadhyamaan, avide purakil cheria murivukaliloode adrenal grandhikalil athicherunnu. shasthrakriyaykk sheshamulla vedanayude theevratha kurayuka, ashupathriyil thaamasikkunnath kuraykkuka, vegathil sukham praapikkuka, neratheyulla rogaavastha kuraykkuka ennivayude kaaryatthil ell. tii. eyum praayum orupole surakshithavum phalapradavumaanennu padanangal theliyichittundu. laparoscopic transperitonial adrenalectomy thaarathamyappeduthumbol laparoscopic retroperotenial adrenalectomy vaikiyulla rogaavastha, vaayile draavakam allengil bhakshanam kazhikkaanulla samayam, ambulation samayam enniva kuraykkunnathaayi 2018 leeii chittayaya avalokanam soochippikkunnu, ennirunnaalum gunanilavaaramillaattha thelivukal kaaranam eee falangalekkurichu anishchithathvamundu. ellah kaaranangalalum marananirakk, aadyakaala rogaavastha, saamoohika saambathika prathyaaghaathangal, pravartthanaparavum shasthrakriyaykk sheshamullathumaaya paaraamettarukal thudangiya falangalkku, rund edapedalukaludeyum falangalekkurichu thelivukal anishchithathvathilaanu. parimithamaaya retroperitoniyal sthalathinullil uyarnna mardhamullah kaarban dye ooksaid proyil ulppedunnu, athinaal uyarnna apakadasaadyathayullavaril vrukkaykku parikkelkkaam.
chilappol sarjanmaar robot sahaayathode adrenalectomical nadathunnu. camera upakaranangalum gadippicha robotic kaikal upayogichu cheria murivukaliloode (murivukal) avar sasthrakriya nadathunnu. camera doctormark shasthrakriyayude hye defenision, magnified, 3D kazhcha nalkunnu. sankeernathakal, raktha nashtam allengil marananirakk ennivaykkulla rund mettaa vishakalanagalil laparoscopic, robot assisted adrenalectomy enniva thammil kaaryamaaya vyathyasangalonnum kandethiyitla, ennirunnaalum robotic adrenalectomic kooduthal pravartthana samayavum shasthrakriyayude uyarnna chelavum chelavil ashupathriyil thamasam kuravaayirunnu.
shasthrakriyaykk sesham.
shasthrakriyaykk sheshamulla paricharanam adrenalectomy enthinuvendiyaanu nadathiyathennathine aasrayichirikkunnu. courtisol uthppaadippikkunna adenomayude adrenalectomic sesham, hypothalamic-pityoottari-adrenal (echpie) axis veendedukkunnathuvare courtison allengil hydrocourtisone polulla exogenous glucocorticoiducal upayogichu rogikale chikilsikkanam. ekapaksheeyamaaya adrenalectomic sesham eee prakriyaykku 6 muthal 18 maasam vare eduthekkaam. athupole, (subclinical) kushing syndromine adrenalectomic vidheyamaaya rogikalkku, periopparetteevu glucocorticoid therapy, echu. pii. eiii axis veendedukkalinte posttparetteevu vilayiruthal enniva aavasyamaanu. pheochromocytomica adrenalectomic vidheyamaaya rogikalkku, deerghakaala fooloo upp aavasyamaanu, kaaranam rogikalil 10-15% aavarthichekkaam. praadhamika aldosteronism moolam uyarnna rakthasammardham (secondary hypertension) ullavarkku, adrenalectomy ekadesham <aii. dii. 1> enna klinikkal rogashanti nirakk nalkunnu.
rund adrenal grandhikalum neekkam cheythaal, rogikk jeevithathinu aavashyamaaya adrenal hormonukal srishtikkaan kazhiyilla (praadhamika adrenal aparyapthatha). vooliyam kurayal, hypotension, hyponetremia, hyperclamia, panii, vayaruvedana ennivayaanu adayaalangalum lakshanangalum. ithinu glucocortical, mineralocourticoidukal (floodrocourtisoon) ennivayulppede neekkam cheytha adrenal grandhikal ulppaadippikkunna hormonukal upayogichu aajeevanantha chikitsa aavasyamaanu. sammarddathilaayirikkum anubaadhayude samayatho allengil adrenal prathisandhi undaakumbozho glucocorticoid doses vardhippikkendathundu.
adrinalectamiyethudarnnathu adrenal grandhikalil ninnu androjan uthppaadanam nashtappedunnathinte falamaayi androjan kurravulla sthreekalkku, dehydroapiandrostro (daya) maattisthaapikkunnath pariganikkaam. opttimais cheytha glucocorticoid, mineralocourticoid maattisthaapikkal enniva undaayirunnittum kuranja kamashakti, vishada lakshanagal, koodaathe/allengil kuranja oorjja nila enniva adayaalangalilum lakshanangalilum ulppedunnu.
sankeernathakal.
aparyapthamaaya courtisol uthppaadanam, theevramaaya vrukka parikk, shasthrakriyaykk sheshamulla rakthasraavangal, aduthulla avayavangalkk kedupaadukal, shasthrakriyaykk sheshamulla anubadha enniva adrenalectomy ninnulla sankeernathakalil ulppedaam.

