腹膜后腹腔镜手术治疗原发性醛固酮增多症130例

Retroperitoneal laparoscopic management of primary aldosteronism with report of 130 cases

目的 探讨腹膜后腹腔镜手术治疗原发性醛固酮增多症的临床价值。方法2 0 0 0年 2月到 2 0 0 3年 9月 ,我院对 130例 (男 5 4例 ,女 76例 )原发性醛固酮增多症患者行腹膜后腹腔镜手术治疗 ,其中肾上腺皮质腺瘤 119例 ,特发性肾上腺皮质增生 11例 (其中 2例为单侧皮质增生 ) ;肾上腺皮质腺瘤中 6 1例行肾上腺全切、5 8例行肾上腺部分切除术 ,肾上腺皮质增生采用单侧肾上腺全切手术。所有病例术前均有高血压和低血钾表现 ,及血浆醛固酮水平升高伴血浆肾素活性降低。结果 130例手术均获得成功。手术时间 15～ 2 2 5min ,中位数为 4 3min ;术中出血量 0～ 2 0 0ml(出血量小于 5ml计出血量为 0 ) ,中位数为 2 0ml;术后住院时间 3～ 9d ,平均 (5 1± 1 3)d。所有病例术后 1个月内血钾恢复正常 ,醛固酮 /肾素比值明显降低 ,在未用降压药物情况下 ,88例 (6 8% )术后 2个月内血压恢复正常。随访 82例 ,6个月至 2年无明显并发症。结论 应用腹腔镜行腹膜后肾上腺全切除或部分切除术治疗原发性醛固酮增多症安全、可行。

Objective To evaluate retroperitoneal laparoscopic partial or total adrenalectomy for primary aldosteronism Methods From February 2000 to September 2003, 130 patients (76 women and 54 men) with a confirmed diagnosis of primary aldosteronism underwent retroperitoneal laparoscopic operation Of the 130 cases, there were 119 cases with aldosteron producing adenoma and 11 cases with idiopathic adrenal hyperplasia (unilateral of 2 cases) Eleven cases with idiopathic adrenal hyperplasia underwent unilateral adrenalectomy Of the 119 cases with aldosterom producing adenoma, 61 cases underwent total adrenalectomy, and 58 cases underwent partial adrenalectomy All cases were with preoperatively high plasma aldosterone, low plasma rennin and hypokalemia and arterial hypertension Results Operations were successfully performed in all cases The operative time ranged from 15 to 225 min (Md = 43 min) and the operative bleeding ranged from 0 to 200 ml (Md = 20 ml ,zero bleeding means that less than 5 ml) without blood transfusion The hospital length of stay was ranged from 3 to 9 d [mean (5 1±1 3) d] No major complication occurred Kalemia was normalized within one month and aldosterone/plasma remin activity ratio was decreased obviously in all cases Postoperatively blood pressure was normalized within 2 month in 88 cases without using any drug Conclusion It is safe and practical to perform retropreitoneal laparoscopic partial on total adenalectomy on the patients with primary aldosteronism