特发性醛固酮增多症的手术治疗效果分析

The Surgical Effect of Idiopathic Hyperaldosteronism

目的 :探讨特发性醛固酮增多症 (IHA)的手术治疗效果及意义。方法 :分析 31例IHA的临床特点 ;17例表现为一侧肾上腺结节样增生 ,对侧正常或弥漫增生者行手术治疗。对手术病例的选取原则及疗效影响因素进行评价。结果 :共随访到手术病例 15例 ,血钾恢复正常率 80 % (12 / 15 ) ,高血压治愈率 13.3% (2 / 15 ) ,缓解率 6 0 % (9/ 15 ) ,手术无效率 2 6 .7% (4/ 15 )。治愈组术前血浆肾素水平 (PRA)正常率 5 0 % (1/ 2 ) ,持续高血压组为 30 .8% (4/ 13) (P >0 .0 5 ) ;治愈组高血压病程 6 .5年 ,持续高血压组 6年 (P >0 .0 5 )。 4例无效者 2例行部分肾上腺切除 ,2例一侧肾上腺切除后对侧复发结节。结论 :单侧肾上腺结节增生型IHA有功能自主性 ,手术可治愈或改善高血压 ,消除低钾引起的心肾毒性。术式选择不当、病灶切除不彻底或复发 ,是影响手术效果的重要因素。

Objective: To study the surgical effect of idiopathic hyperaldosteronism(IHA). Methods: Clinical feature s of 31 cases of IHA were analysed. 17 cases accepted adrenalectomy or partial ad renalectomy. Surgical indications, and factors associated with results were eval uated. Results: 15 surgical cases were followed. 12 cases(80 % ) had normal serum potassium level; BP was normalized in 2 cases(13.3%); Hyperte nsion persisted but BP control was significantly improved in 9 cases(60%), and n ot improved in the remaining 4 patients(26.7%). The rate without suppressed PRA was 50%(1/2) in normal BP group, and 30.8%(4/13) in remained hypertension group( P>0.05).The durations of hypertension of latter was similar with that of fo rmer (6.5 years vs 6 years, P>0.05). In 4 cases whose BP remaining not impr oved,2 accepted partial adrenalectomy,and the other two recurred opposite adrena l nodules after adrenalectomy. Conclusion: IHA with unilat er al hyperplastic nodule became autonomous and potentially can be cured surgically .Dispeled cardiotoxic and nephrotoxic through surgery had specific benefits beyo nd BP reduction. The factors related with surgical effect included insufficient surgery or recurrence.