后腹腔镜治疗皮质醇症围手术期激素替代方案的探讨

A Study on Perioperative Endocrine Therapy for Retroperitoneal Laparoscopic Adrenalectomy of Cushing's Syndrome

目的:探讨皮质醇增多症肾上腺皮质腺瘤行后腹腔镜手术的围手术期激素替代治疗新方案及效果。方法:回顾性分析2007年5月～2010年5月经后腹腔镜手术切除和病理检查确诊为皮质醇增多症肾上腺皮质腺瘤82例患者围手术期激素替代治疗方案及效果:采用简化的激素替代方案,于后腹腔镜肾上腺瘤切除前后分别给予氢化可的松100 mg,术后当天再静滴氢化可的松200 mg,术后第1天静滴氢化可的松100 mg Q8 h,第2天减量至100 mg Q12 h,第3天减量至50 mg Q12 h,后改强的松口服25 mg Qd,每3天减量5 mg至10～15 mg时维持剂量。结果:所有患者均顺利完成后腹腔镜手术切除肾上腺瘤,未出现手术相关并发症。检测术后第1天和第5天血浆皮质醇水平正常,围手术期间未出现明显激素撤退症状,临床症状明显改善。结论:该治疗方案能有效控制激素撤退综合征的发生,简化了用药方案,是皮质醇增多症肾上腺皮质腺瘤腹腔镜手术围手术期激素替代治疗简单和有效的方法。

Objective：To investigate the method and effect of perioperative endocrine therapy for retroperitoneal laparoscopic adrenalectomy of Cushing＇s syndrome （adrenocortical adenoma）. Methods： Clinical laboratory data and outcomeof 82 cases of Cushing＇s syndrome（adrenocortical adenoma）which diagnosed by clinical and pathologi- cal method were retrospectively analyzed at west china hospital during 2007-2010. The brief perioperative endo- crine therapy recommended that 100 mg hydrocortisone should be given by intravenous injection before and after removal of adrenal adenoma, another 200 nag hydrocortisone given over thefirst 24 h after operation, then 100 mg Q8 h, 100 mg Q12 h, 50 mg Q12 h hydrocortisone on next three days thereafter. Oral prednisolone （25 rag） should be used instead of intravenous drug after 3 days, followed by a reduction of 5 mg every 3 days until a main- tenance dosage （10 to 15 rag） was reached. Results.. All 82 cases were performed the adrenalectomy successfully without any complications.4Plasma cortisol levels were markedly stable on day 1 and day 5, the patient＇s clinical symptoms improved in hospital while the hormone withdrawal symptoms were not distinct. Conclusions： The treat- ment can effectively control the occurrence of steroid withdrawal syndrome, and this perioperative endocrine thera- py for retroperitoneal laparoscopic adrenalectomy of CushinKs syndrone（adrenocortical adenoma ）is a brief and ef- fective method.