不同肾上腺切除方式治疗复发性库欣病疗效分析

Comparison between total and subtotal adrenalectomy procedures for recurrent Cushing's disease

目的探讨不同肾上腺切除方法治疗复发性库欣病临床效果。方法经垂体治疗后库欣病复发患者32例,男7例,女25例,平均年龄(31.9±10.4)岁。随机分为两组:18例患者右侧肾上腺全切+左侧次全切除(次全切组);14例双侧肾上腺切除(全切组)。结果术后随访18～60个月,32例患者术后24h游离皮质醇降至正常范围,81.5%(22/27)高血压、65.4%(17/26)糖尿病或糖耐量异常患者术后血压、血糖降至正常范围,66.7%(12/18)女性闭经患者月经恢复正常,两组间血压、血糖及月经恢复情况无统计学差异。次全切除组1例术后复发,5例患者无需补充糖皮质激素;全切组14.3%(2/14)出现Nelson综合征。结论肾上腺全切和肾上腺次全切除是治疗库欣病复发的两种有效方法。

Objective To discuss clinical efficacy of different techniques to resect adrenal gland for recurrent Cushing's disease.Methods We reviewed the cases(32 patients,7 were men and 25 were women) of recurrent Cushing's disease postoperatively with a mean age of(31.9±10.4) years.It included 18 cases of total right adrenalectomy and left subtotal adrenalectomy(subtotal resection group) and 14 cases bilateral total adrenalectomy(total resection group).Results Hypercortisolism disappeared after surgery and the 24 hours UFC decreased within the normal range.81.5% of those with hypertension and 65.4% of those with diabetes mellitus or impaired glucose tolerance showed normal blood pressure and blood glucose respectively and 66.7% female returned to normal menstrual cycle after operation.There was no significant difference of normalization of blood pressure,blood glucose and menstrual cycle between two groups.One case with hypercortisolism recurrence of the subtotal resection group was cured by the resection of the residual gland.All patients of the total resection group required glucocorticoid replacement therapy,while 5 cases of subtotal resection group didn't.Nelson syndrome occurred in 2 patients(14.2%) of the total bilateral adrenal resection group.Conclusions Both subtotal and total adrenalectomy groups show desirable clinical efficacy in treatment of recurrent Cushing's disease.