后腹腔镜下保留肾上腺手术治疗腺瘤型原发性醛固酮增多症

Retroperitoneal laparoscopic partial adrenalectomy for the treatment of primary hyperaldosteronism with adrenal adenoma

目的提高对后腹腔镜手术治疗腺瘤型原发性醛固酮增多症时保留正常肾上腺组织重要性的认识。方法经后腹腔镜手术治疗肾上腺皮质腺瘤型原发性醛固酮增多症患者196例。男78例，女118例。年龄16～69岁，平均（41±12）岁。病程（90±65）个月。196例均存在血浆醛固酮水平升高伴血浆肾素活性降低，均有顽固性高血压和低血钾病史。对保留。肾上腺组织患者的术后疗效、高血压和低血钾恢复情况进行临床分析。结果行保留。肾上腺组织的肿瘤剜除术145例，患侧肾上腺部分切除术51例。196例手术均获成功。手术时间15～87min，中位数33min。术中出血量5～200ml，中位数20ml。术后病理报告均为肾上腺皮质腺瘤。术后住院时间2～5d，平均（2．7±1．3）d，恢复过程顺利。196例随访6个月～3年，平均1．8年，168例（85．7％）血压恢复正常；27例（13．8％）血压高于正常范围，复查。肾素-血管紧张素-醛固酮水平在正常范围，复查。肾上腺CT未见明显异常，上述患者血钾在正常范围；1例患者血压升高，再次手术切除遗留腺瘤后血压恢复正常。196例术后均无心慌、乏力、发热、血压下降等肾上腺皮质功能不足表现。结论后腹腔镜下肾上腺腺瘤剜除术或患侧肾上腺部分切除手术安全性与疗效肯定，并能保存相应肾上腺皮质功能，是腺瘤型原发性醛固酮增多症合理的手术方式。

Objective To evaluate the clinical application of retroperitoneal laparoscopic adrenal gland sparing adrenalectomy in the treatment of primary hyperaldosteronism with adrenal adenoma. Methods From 2001 to 2006, clinical data of 196 primary hyperaldosteronism with adrenal adenoma patients （78 males and 118 females with mean age of 41±12, ranging 16 69 years old） confirmed during operation were retrospectively analyzed. All cases were with preoperatively high plasma aldosterone, low plasma renin, hypokalemia and arterial hypertension. Results Retroperitoneal laparo scopic adrenalectomy were successfully completed in all cases. No major complication occurred. Of them, partial adrenalectomies were performed in 51 cases and enucleations of adrenal adenoma were performed in 145 cases. The operative time was ranged from 15 to 87 rain （MD=33 min） and the estimated blood loss was ranged from 5 to 200 ml （MD=20 ml）. There was no case accepted transfusion. The length of hospital stay was ranged from 2 to 5 d （mean 2.7±1.3 d）. All the 196 cases were fol lowed up with the range from 6 months to 3 years （mean, 1.8 years）. Postoperatively, kalemia was normalized in all cases, blood pressure was normalized in 168 cases （85.7%）. The abnormal blood pressure cases were under control with anti-hypertension drugs. The CT scan showed adrenal glands were normal. Serum test showed normal hormonal levels. The serum potassium levels were in normalrange in all cases. One cases with abnormal post operative blood pressure had accepted second surgery to remove the adrenal adenoma and the blood pressure turned to be in normal range afterwards. Conclusion Retroperitoneal laparoseopic adrenal gland sparing adrenalectomy is a safe and feasible tech- nique and is the first choice in the management of primary hyperaldosteronism with adrenal adenoma.