肾上腺部分切除术与肾上腺全切术治疗原发性醛固酮增多症的争议与决策

Controversy and strategy of partial versus total adrenalectomy in the treatment of primary aldosteronism

确诊为醛固酮瘤及单侧肾上腺增生的原发性醛固酮增多症(PA)患者首选手术治疗。手术目的是切除肾上腺醛固酮高分泌组织,改善预后。目前研究显示,肾上腺部分切除术与肾上腺全切术治疗PA均可获得临床治愈,但术式选择仍存在争议。本文探讨不同术式治疗不同PA亚型的疗效与安全性、术后皮质醇水平的变化、术后复发以及手术技术等情况,以寻找不同PA亚型的最佳手术方式,使患者获益最大。

Primary aldosteronism(PA)patients diagnosed with aldosterone-producing adenoma and unilateral adrenal hyperplasia are preferred for surgical treatment.The aim of the operation is to remove the hypersecretory aldosterone tissue of adrenal and to improve the prognosis.Current studies have shown that both partial adrenalectomy and total adrenalectomy can achieve clinical cure for PA,but the choice of surgical methods is still controversial.This paper discusses the efficacy and safety,postoperative changes in cortisol level,postoperative recurrence and surgical techniques of different surgical methods in the treatment of different PA subtypes,so as to find the best surgical methods for different PA subtypes and to maximize the benefits for patients.