腹腔镜肾上腺全切术与部分切除术治疗肾上腺醛固酮腺瘤的对比研究

Laparoscopic partial versus total adrenalectomy for aldosterone-producing adenoma

目的探讨经腹腔途径腹腔镜单侧肾上腺全切与部分切除治疗肾上腺醛固酮腺瘤的围手术期及长期血压预后结果之间有无差别。方法 2004年4月至2009年6月共收治103例肾上腺醛固酮腺瘤患者,其中69例(67%)患者行腹腔镜肾上腺全切术(单侧肾上腺全切组),34例(33%)患者行腹腔镜肾上腺部分切除术(肾上腺部分切除组)。回顾性分析所有患者的临床资料,并随访其术后血压恢复情况及血浆醛固酮、血钾的变化。结果 103例手术均获成功,无中转开放手术患者。两组患者在手术时间、手术出血量、术中及术后并发症、术后醛固酮、术后血钾差异无统计学意义(P均>0.05)。在中位时间为37(9～82)个月的随访期内,单侧肾上腺全切组44例患者血压恢复正常,24例患者血压好转,1例患者血压治疗无效;肾上腺部分切除组21例患者血压恢复正常,9例患者血压好转,4例患者血压治疗无效。两组间行χ2检验差异无统计学意义。肾上腺部分切除组3例患者在术后血压曾好转,但分别在8个月、1.5年、3年血压重又升高至术前水平,且伴有血浆醛固酮的重新升高。其余100例患者的血钾及血浆醛固酮水平在术后6个月复查时均恢复到正常范围内。结论肾上腺部分切除术治疗醛固酮腺瘤与单侧肾上腺全切术相比在术后激素不足发生率及改善术后血压等方面并无明显差别,但是肾上腺部分切除术存在复发的可能,相比之下单侧肾上腺全切术疗效更为确切,因此对于单侧肾上腺腺瘤应选用单侧肾上腺全切术。

Objective To evaluate differences in peri-operative and long-term results between laparoscopic partial and total adrenalectomy for aldosterone-producing adenoma.Methods The clinical data from 103 patients with primary aldosteronism caused by aldosterone-producing adenoma between April 2004 and June 2009 were retrospectively analyzed.69（67%） patients underwent laparoscopic partial adrenalectomy（LPA） and 34（33%） underwent laparoscopic total adrenalectomy（LTA）.Results All procedures were successfully finished by laparoscopy,without conversion to open surgery.No major intraoperative or postoperative complications were observed.There was no significant difference between LPA and LTA in duration of surgery,intra-operative blood loss,mean hospital stay after operation,complications,and postoperative plasma potassium and aldosterone（all P0.05）.During a median of 37（9-82） months of follow-up,there was no remarkable difference in prognosis of blood pressure： 44 cases were cured,24 cases were improved,and 1 case failed in LTA;while 21 cases were cured,9 cases were improved,4 cases failed in LPA.3 cases with LPA had blood pressure improved after operation,but high blood pressure associated with high plasma aldosterone recurred after 8 months,1.5 years and 3 years.Postoperative plasma potassium and aldosterone were within normal ranges in the other 100 cases 6 months after operation. Conclusion There is no significant difference between LPA and LTA in duration of surgery,intraoperative blood loss,mean hospital stay after operation,complications,and postoperative adrenocortisol deficiency rate and improvement of blood pressure.Given the recurrence possibility of aldosterone-producing adenoma by LPA,the curative effect of LTA is comparatively more definite.So LTA is recommended for unilateral aldosterone-producing adenoma.