{"id":78365,"date":"2018-06-18T08:14:14","date_gmt":"2018-06-18T08:14:14","guid":{"rendered":"http:\/\/humanitasnet-new.local\/cure\/laparoskopska-adrenalektomija-lecenje-nodularnog-adrenalnog-poremecaja\/"},"modified":"2018-06-18T08:14:14","modified_gmt":"2018-06-18T08:14:14","slug":"laparoskopska-adrenalektomija-lecenje-nodularnog-adrenalnog-poremecaja","status":"publish","type":"cure","link":"https:\/\/humanitas-net.humweb.webiz.team\/sr\/treatments\/laparoskopska-adrenalektomija-lecenje-nodularnog-adrenalnog-poremecaja\/","title":{"rendered":"Laparoskopska adrenalektomija (le\u010denje nodularnog adrenalnog poreme\u0107aja)"},"content":{"rendered":"<h2 class=\"MsoNormal\" style=\"text-align: justify; text-justify: inter-ideograph;\" id=\"dijagnoza-kako-se-leci-adrenalno-oboljenje\">Dijagnoza: kako se le\u010di adrenalno oboljenje?<\/h2>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-justify: inter-ideograph;\"><span style=\"mso-spacerun: yes;\">\u00a0<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-justify: inter-ideograph;\">Dijagnoza se zasniva na klini\u0161kim znacima, rezultatima laboratorijskih ispitivanja i imid\u017eing dijagnostici (MR, CT, nuklearne ispitivanja kao \u0161to su scintigrafija ili PET). Neophodno je omogu\u0107iti saradnju me\u0111u razli\u010ditim specijalisti\u010dkim granama medicine, radiolozima, specijalistima nuklearne medicine, geneti\u010darima i hirurzima.<\/p>\n<h2 id=\"\"><\/h2>\n<h2 class=\"MsoNormal\" id=\"kako-se-leci-adrenalno-oboljenje\">Kako se le\u010di adrenalno oboljenje?<\/h2>\n<p class=\"MsoNormal\"><span style=\"mso-spacerun: yes;\">\u00a0<\/span>Nodularno adrenalno oboljenje u slu\u010daju postojanja hirur\u0161kih indikacija naj\u010de\u0161\u0107e se tretira laparoskopskom adrenalektomijom: unilateralna (adenoma, incidentalomi funkcionalnih lezija, feohromocitom) ili bilateralna ( nodularna adrenalna hiperplazija, Ku\u0161ingovo oboljenje nakon operacije pituitarne \u017elezde). Klasi\u010dan hirur\u0161ki pristup ili kod odre\u0111enih slu\u010dajeva,<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>krioablacija adrenalne lezije re\u0111e su primenjivane metode.<\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-justify: inter-ideograph;\">Tokom laparoskopske adrenalektomije pacijent se uvodi u op\u0161tu anesteziju, pozicionira u lateralni decubitus nakon adekvatne farmakolo\u0161ke pripreme. U slu\u010daju feohromocitoma, pacijent se priprema primenom alfa blokatora (doksazosin, fenoksibenzamin) u cilju stabilizacije krvnog pritiska. Drugi primenjivani lekovi mogu biti beta-blokatori ili blokatori kalcijumskih kanala.<\/p>\n<p class=\"MsoNormal\">U slu\u010daju aldosteronizma, regulacija krvnog pritiska posti\u017ee se administracija antagonista aldosterone, naj\u010de\u0161\u0107e udru\u017eenih sa udru\u017eenim efektom natrijuma u slu\u010daju hipokalijemije.<\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-justify: inter-ideograph;\"><span lang=\"DE\" style=\"mso-ansi-language: DE;\">U preoperativnom toku neophodno je plasirati kateter. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-justify: inter-ideograph;\"><span lang=\"DE\" style=\"mso-ansi-language: DE;\">\u00a0<\/span>U principu, 4 do 5 manjih incizija se na\u010dini pre uvo\u0111enja laparoskopskih procedura. Pristup je transperitonealan ili retropeitonealan u zavisnosti od detaljne preoperativne operacije. U odabranim slu\u010dajevima, mo\u017ee se izvr\u0161iti parcijalno uklanjanje adrenalnih \u017elezda. Prose\u010dno trajanje adrenalektomije je oko 2 sata.<\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-justify: inter-ideograph;\">Na kraju operativnog zahvata, plasira se dren koji se uklanja 2-3 dana nakon operativnog postupka. Prose\u010dno trajanje bolni\u010dkog le\u010denja je 3-4 dana.<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>Pacijent je sposoban da se samostalno kre\u0107e i hrani nakon prvog postoperativnog dana uz primenu supstitucione terapije.<\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-justify: inter-ideograph;\">Nakon uklanjanja adenoma koji sekretuje kortizol, kod pacijenta nastaje hipoadrenalizam usled privremene insuficijencije adrenalne \u017elezde, koji mo\u017ee zahtevati nekoliko meseci u cilju rekativacije. Tokom ovog perioda pacijent bi trebalo biti na terapiji kortizona.<\/p>\n<h2 class=\"MsoNormal\" style=\"text-align: justify; text-justify: inter-ideograph;\" id=\"kako-se-vrsi-monitoring-pacijenta-nakon-laparoskopske-adrenalektomije\">Kako se vr\u0161i monitoring pacijenta nakon laparoskopske adrenalektomije?<\/h2>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-justify: inter-ideograph;\">Postoperativna nega nakon operacije nodularnog adrenokoritkalnog oboljenja bazira se na dve kategorije u zavisnosti od histopatolo\u0161kog nalaza.<\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-justify: inter-ideograph;\">U slu\u010daju benignog poreme\u0107aja (na primer adrenalnog adenoma) u zavisnosti od rezultata laboratorijskih i ultrazvu\u010dnih nalaza, pra\u0107enje se vr\u0161i naj\u010de\u0161\u0107e na svaka 3 meseca u postoperativnom periodu.<\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-justify: inter-ideograph;\">Po otpustu i daljem pra\u0107enju, endokrinolo\u0161ke kontrole, \u010dak i u odsustvu odre\u0111enih komplikacija mo\u017ee se nastaviti sa redovnim monitoringom.<\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-justify: inter-ideograph;\">Na\u0161i rezultati<\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-justify: inter-ideograph;\">U na\u0161oj ustanovi, laparoskopska adrenalektomija predstavlja sigurnu metodu le\u010denja od 1992.<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>(prva u Evropi) sa preko 400 operisanih pacijenata.<\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-justify: inter-ideograph;\"><span style=\"mso-spacerun: yes;\">\u00a0<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-justify: inter-ideograph;\">Navedeni operativni zahvati predmet su brojnih nau\u010dnih publikacija kao i prezentacija na najpresti\u017enijim nacionalnim i internacionalnim urolo\u0161kim konferencijama.<\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-justify: inter-ideograph;\">\u00b7<span style=\"mso-spacerun: yes;\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>www.ncbi.nlm.nih.gov\/pubmed\/11490226<\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-justify: inter-ideograph;\">\u00b7<span style=\"mso-spacerun: yes;\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>www.ncbi.nlm.nih.gov\/pubmed\/14690487<\/p>\n","protected":false},"featured_media":0,"template":"","class_list":["post-78365","cure","type-cure","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.3 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Laparoskopska adrenalektomija (le\u010denje nodularnog adrenalnog poreme\u0107aja) - Humanitas.net<\/title>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"sr_RS\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Laparoskopska adrenalektomija (le\u010denje nodularnog adrenalnog poreme\u0107aja) - Humanitas.net\" \/>\n<meta property=\"og:description\" content=\"Dijagnoza: kako se le\u010di adrenalno oboljenje? \u00a0 Dijagnoza se zasniva na klini\u0161kim znacima, rezultatima laboratorijskih ispitivanja i imid\u017eing dijagnostici (MR, CT, nuklearne ispitivanja kao \u0161to su scintigrafija ili PET). Neophodno je omogu\u0107iti saradnju me\u0111u razli\u010ditim specijalisti\u010dkim granama medicine, radiolozima, specijalistima nuklearne medicine, geneti\u010darima i hirurzima. 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