后腹腔镜肾上腺肿瘤切除术后肾上腺危象8例

Adrenal crisis after retroperitoneal laparoscopic adrenalectomy: An analysis of 8 cases

目的总结后腹腔镜肾上腺肿瘤切除术后肾上腺危象的治疗与预防。方法对8例肾上腺肿瘤切除术后发生肾上腺危象患者的病例资料进行回顾性分析。结果 8例中,皮质腺瘤7例(Cushing综合征),双侧非霍奇金淋巴瘤1例。3例术后第1天发生肾上腺危象,经激素治疗好转;5例发生于出院后2月内,在消化道或肺部感染后出现,经激素冲击替代治疗,抗休克、抗感染等对症支持治疗,其中3例合并呼吸衰竭,上呼吸机治疗;8例均抢救治疗成功。结论肾上腺危象病情危急,应积极抢救。一侧因肾上腺肿瘤切除而对侧肾上腺萎缩或双侧切除的患者应注意激素替代治疗。

Objective To review the treatment and prevention of adrenal crisis after retroperitoneal laparoscopicly adrenalectomy. Methods Clinical data of 8 patients with adrenal crisis after retroperitoneal laparoscopic adrenalectomy were retrospectively analyzed. Results Among 8 cases,7 were diagnosed as adrenal cortical adenoma（ Cushing＇ s syndrome）,one as bilateral non-Hodgkin lymphoma. Three patients developed adrenal crisis on the first postoperative day,and improved after hormone replacement therapy. Five patients developed adrenal crisis secondary to digestive tract or pulmonary infections 2 months after discharge and improved after hormone replacement,anti-shock and anti-infection therapies. Three patients complicated with respiratory failure had mechanical ventilation for life-support. All cases were cured successfully. Conclusion Patients with adrenal crisis are always in critical condition,and emergent treatment is necessary once diagnosed. Hormone replacement therapy should be given to patients under unilateral adrenalectomy with contralateral atrophy or patients under bilateral adrenalectomy.