氢化可的松在后腹腔镜手术治疗皮质醇增多症围手术期的应用研究

Perioperative use of hydrocortisone in retroperitoneal laparoscopic surgery for Cushing＆#39;s syndrome

目的：探讨氢化可的松在后腹腔镜下手术治疗皮质醇增多症围手术期激素替代中的应用及效果。方法56例皮质醇增多症患者在后腹腔镜手术治疗围手术期应用氢化可的松激素替代方案治疗，术前不用激素，术中及术后第1、2天予静滴氢化可的松，从第2天开始口服氢化可的松，并逐渐减量至维持治疗。术后密切观察临床症状，并间断监测血、尿皮质醇来评价该激素替代治疗效果。结果2例术后出现轻微皮质功能不全症状，予加大口服剂量后症状消失；6例血皮质醇（cortisol，Cor）低于正常范围，未出现皮质功能低下症状，其同天尿Cor均在正常范围内。术后第7天尿皮质醇与术前相比明显降低，差异有统计学意义；术后第6、7天血皮质醇与术前相比明显降低，差异有统计学意义。患者术后均未出现伤口感染，恢复良好。结论氢化可的松在后腹腔镜下治疗皮质醇增多症患者围手术期激素替代治疗中是安全可行的。

Objective To investigate the application and effect of hydrocortisone during perioperation of retroperitoneum laparoscopic surgery for Cushing＇s syndrome.Methods Data of 56 cases of Cushings＇s syndrome treated by hormone replacement therapy of hydrocortisone were retrospectively analyzed .The hormone replacement therapy was as the following：no hormone before surgery, intravenous drip of hydrocortisone during and the 1st and 2nd day after surgery, oral intake of hydrocortisone from the 2nd after surgery.Clinical symptoms were observed and plasma,24h urine cortisol levels were intermittently measured after the surgery to evaluate the effects of treatment . Results 2 cases had slight cortical dysfunction symptoms, then back to normal after receiving larger dose of hydro-cortisone.6 cases had blood cortisol levels below the normal range , but they did not have cortical dysfunction symptoms, and at the same time their 24h urine cortisol levels were normal .Urine cortisol concentration significantly decreased on the 7th day after surgery, and had significant difference compared with that before surgery .Plasma cortisol concentration significantly decreased on the 6th, 7th day after surgery, and had significant difference compared with that before operation.All the cases recovered well.Conclusion Perioperative hydrocortisone replacement in retroperitoneum laparoscopic surgery for Cushing＆#39;s syndrome is safe.