腹腔镜行肾上腺部分切除术与全切术治疗肾上腺原醛瘤的比较:附235例报告

The comparison of partial and total adrenalectomy for aldosterone-producing adenomas:Report of 235 cases

目的探讨肾上腺部分切除术与全切术治疗腺瘤型原发性醛固酮增多症的效果。方法回顾性分析235例腺瘤型原发性醛固酮增多症患者的临床资料。85例行后腹腔镜下肾上腺全切,150例行后腹腔镜下肾上腺部分切除。结果行肾上腺部分切除组手术时间48.0±15.0 min;术中失血量25.0±10.0 ml;拔引流管时间2.2±1.0 d;术后住院天数7.0±2.5 d;病灶大小15.5±4.5 mm。行肾上腺全切组手术时间37.0±12.0 min;术中失血量23.0±9.0 ml;拔引流管时间2.4±1.2 d;术后住院天数6.8±2.0 d;病灶大小16.0±3.0 mm。部分切除组和全切组术中失血量、拔引流管时间、住院时间及病灶大小差异无统计学意义(P>0.05)。部分切除组手术时间长于全切组(P<0.05)。随访6个月～2年,所有患者血钾恢复正常,198例血压恢复正常。结论对于单发醛固酮腺瘤的患者,行肾上腺部分切除术治疗腺瘤型原发性醛固酮增多症安全、有效,而且保留了部分有功能的肾上腺组织,优于肾上腺全切术。

Objective To discuss the treatment effect of p ,artial and total adrenalectomy for aldosterone-producing adenomas. Methods Data of 235 cases of aldosterone-producing adenomas were reviewed retrospectively. Eighty five patients underwent total adrenalectomy, 150 patients underwent partial adrenalectomy. Results In the group of partial adrenalectomy, mean operative time was 48.0±15.0 min, mean blood loss was 25.0±10.0 ml, mean placement time of drainage tube was 2.2±1.0 d, postoperative hospital stay was 7.0±2.5 d, mean tumour size was 15.5±4.5 mm. In the group of total adrenalectomy, mean operative time was 37.0±12.0 min; mean blood loss was 23.0±9.0 ml; mean placement time of drainage tube was 2.4±1.2 d; postoperative hospital stay was 6.8±2.0 d; mean tumour size was16.0±3.0 mm. The difference was not statistic significant in mean blood loss, mean placement time of drainage tube, postoperative hospital stay and mean tumour size between total and partial group （P〉0.05）. Mean operative time of total group was significantly less than partial group （P〈0.05）. All the patients were followed up for 6 months to 2 years postoperatively, kalemia was normalized in all cases, blood pressure was normalized in 198 cases. Conclusions Retroperitoneal laparoscopic partial adrenalectomy for unique aldosterone＇producing adenomas is safe and feasible technique. Partial adrenalectomy is better than total adrenalectomy because the residual fuctional adrenal tissue canbe reserved.