皮质醇症的外科治疗(附46例报告)

Surgical management of hyperadrenocorticism (report of 46 cases)

目的提高皮质醇症的外科治疗效果。方法总结４６例患者不同手术方法的疗效及随访情况。结果术后患者症状均得到缓解，随访１８～１６０个月，疗效满意２３例，继发垂体瘤５例，复发３例，终生需部分或全部激素替代１５例，其中３例发生肾上腺皮质危象。结论经蝶骨垂体瘤摘除术是皮质醇症较理想的病因治疗方法。单纯肾上腺手术而忽略垂体病变常难以取得满意疗效，二期垂体手术极易产生皮质功能低下，因此，仔细检查垂体应列为常规。针对肾上腺的手术中，带蒂肾上腺背部皮下移位术，可免于激素替代，复发时再手术简单，是目前较为合理的手术方法。

Objective To evaluate different surgical procedures for the treatment of hyperadrenocorticism. Methods A retrospective study and evaluation of different surgical procedures undertaken from 1978 to 1998 for the treatment of 46 cases of hyperadrenocorticism has been made.The patients have been followed up for 18160 months with a mean of 56 months.A satisfactory result has been achieved in 23.Everlasting hormone replacement has been needed after adrenal surgery in 15 patients and 3 of them has had repeated crisis of acute adrenocortical insufficiency. Results Pituitary adenoma has been detected after adrenal surgery in 5 patients and relapase of hyperadrenocorticism occurred in 3 of them. Conclusions Transsphenoidal removal of a pituitary adenoma is the treatment of choice for the treatment of hyperadrenocorticism.Total bilateral resection of the adrenal glands is still practiced in some hospitals and dorsal subcutaneous transposition of a pedicled adrenal gland is recommended.Subtotal resection of bilateral adrenal glands would also achieve a satisfactory result in most patients.