机器人辅助后腹腔镜肾上腺醛固酮瘤切除术

Retroperitoneal robot-assisted laparoscopic surgery for primary aldosteronism

目的探讨机器人辅助后腹腔镜下治疗肾上腺醛固酮瘤的临床应用及手术疗效。方法回顾性分析首都医科大学附属北京安贞医院泌尿外科自2015年1月至2018年1月行机器人辅助后腹腔镜肾上腺醛固酮瘤切除术患者的临床资料及术后随访结果。结果 21例患者,其中男性7例、女性14例,左侧12例、右侧9例,均行保留肾上腺手术,手术均获得成功,手术时间(110. 54±29. 21) min,出血量(25. 12±10. 01) ml,住院时间5. 15～1. 21 d,术后无严重并发症发生。术后随访时间0. 5～2年,比较患者术前与术后1年的血压、血钾、血醛固酮/肾素、降血压药物种类等指标,各项指标均得到明显缓解,差异具有统计学意义(P <0. 05),21例患者中血压恢复正常6例(28. 6%),15例(71. 4%)术后仍持续高血压,其中13例(86. 7%)患者减少降血压药物使用。结论机器人辅助后腹腔镜肾上腺醛固酮瘤切除术安全有效,是肾上腺原发性醛固酮增多症外科手术治疗的较好选择。

Objective To discuss the clinical application and therapeutic effect of retroperitoneal robot-assisted laparoscopic surgery for aldosterone-producing adenoma( APA) of primary hyperddosteronism( PHA). Methods To make a retrospective analysis of patients with APA of PHA admitted to our department from Jan. 2015 to Jan. 2018. These patients underwent retroperitoneal robot-assisted laparoscopic surgery.We collected basic information of the patients,perioperative data,postoperative follow-up,results,etc.Results Operations were successfully performed in 21 cases,all cases undergone adrenal sparing surgery( ASS) and 0. 5-2 years of follow-up,no severe complications were observed. The operative time was( 110. 54 ±29. 21) min and the operative bleeding was( 25. 12 ± 10. 01) ml. The hospital length of stay was5. 15-1. 21 day. After 1 year,comparing with preoperative and postoperative blood pressure,blood potassium,ARR( Aldosterone/renin ratio),kinds of antihypertensive drugs,all the indexes was significantly reduced,statistically differences is clear( P < 0. 05). Blood pressure returned to normal in 6 cases( 28. 6%),blood pressure was still high in 15 cases,15 cases( 71. 4%) continued high blood pressure,of which 13 cases( 86. 7%) patients reduced antihypertensive drug use. Conclusions Retroperitoneal robot-assisted laparoscopic surgery for APA of PHA was a safe technology and its effect was reliable.