原发性醛固酮增多症的诊断与外科治疗

Diagnosis and surgical Treatment of primary Aldosteronism

目的提高原发性醛固酮增多症（primary aldosteronism，PA，简称原醛症）的诊治水平。方法分析1988-2008年该院收治的120例PA的临床资料，其中肾上腺皮质腺瘤111例，肾上腺皮质增生9例，均经手术和病理证实。开放手术79例，后腹腔镜手术41例。肾上腺皮质腺瘤中99例行腺瘤切除，12例行肾上腺部分切除；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及血浆醛固酮水平升高伴血浆肾素活性降低。结果术后随访120例2个月～6年，所有病例术后2个月内血钾恢复正常，醛固酮／肾素比值下降，在未用降压药物情况下，80例术后血压恢复正常；无明显并发症发生。结论体位试验、生化检查、影像学检查联合有助于PA的定性、分型和诊断，B超和CT是PA定位诊断的重要手段，手术是PA的主要治疗方法，腹腔镜手术正成为治疗PA的新方法。

[Objective]To present and evaluate the diagnosis and surgical treatment of primary aldosteronism （PA）. [Methods] From 1988 to 2008, 120 cases of primary aldosteronism we diagnosed and treated, of which 111 were caused by aldosterom-producing adenoma and 9 by idiopathic adrenal hyperplasia. The diagnosis was all ascertained on surgery and pathological studies. 79 patients were treated by open surgery and the other were performed by retroperitoneal laparoscopie surgery. All cases were with preoperatively high plasma aldosterone, low plasma rennin and hypokalemia and arterial hypertension, [Results] All the patients were followed up for 2 months to six years. Kalemia was normalized within two months and aldosterone/plasma rennin activity ratio was decreased obviously in all cases. Postoperatively blood pressure was normalized within 2 months in 80 cases without using any drug. [ Conclusion ] Combination of posture-test, chemistry test and imaging test can contribute to the diagnosis of PA, and surgery is main therapy for PA. Laparoscopic operation is becoming a new and important therapeutic approach.