原发性醛固酮增多症的诊断及治疗观察

Observation on diagnosis and treatment of primary hyperaldosteronism

目的回顾性总结原发性醛固酮增多症(PHA)的诊断及治疗经验。方法选取2009年1月至2013年12月重庆医科大学附属第一医院诊断为PHA患者84例,根据临床表现、血钾、24h尿钾、血气分析、立位醛固酮与肾素比值(ARR)、肾上腺静脉取血(AVS)、卡托普利抑制试验、CT定位检查及术后病理确诊为PHA,采用后腹腔镜肾上腺肿瘤切除术治疗,将患者分为典型临床表现组和不典型临床表现组;比较两组患者肿瘤大小、术前美国麻醉师协会(ASA)分级、手术时间、术中出血量、术前准备时间、术后住院时间。结果典型组与不典型组肿瘤最大径、手术时间、术后住院时间、术中出血量比较,差异无统计学意义(P>0.05);典型组和不典型组术前准备时间、术前ASA分级比较,差异有统计学意义(P<0.05)。结论典型和不典型PHA诊断及治疗无差别;典型组较不典型组手术风险高,需要较长的术前准备时间;AVS适用于早期PHA确诊或定位困难者。

Objective To retrospectively summarize the experience of the diagnosis and treatment of primary hyperaldosteronism（PHA） .Methods 84 cases of PHA in the First Affiliated Hospital of Chongqing Medical University from January 2009 to December 2013 were selected and definitely diagnosed as PHA according to the clinical manifestations ,serum potassium ,24 h urinary potassium ,blood gas analysis ,erect position aldosterone‐to‐renin ratio （ARR） ,adrenal vein sample （AVS） ,Captopril suppression test ,CT location examination and postoperative pathologcal examination .The patients were treated by retroperitoneal laparoscopic adrenalectomy .The patients were divided into the typical clinical manifestation group and the atypical clinical manifestation group ;the tumor size ,preoperative ASA grades ,surgical time ,intraoperative bleeding volume ,preoperative preparation time ,postoperative hospital stay were compared between the two groups .Results The maximum tumor diameter ,surgical time ,intraoperative bleeding volume ,postoperative hospital stay had no statistical differences between the typical clinical presentation group and atypical clinical presentation group （P 〉0 .05） ;while the preoperative preparation time and preoperative ASA grades had statistically significant differences between the two groups（P 〈 0 .05） .Conclusion Typical and atypical PHA have no difference in diagnosis and treatment ;the surgical risk in the typical group is higher than that in the atypical group ;and longer preoperative preparation time is needed in the typical group ;AVS is suitable for the early PHA diagnosis or the case of positioning difficulty .