后腹腔镜保留正常肾上腺与肾上腺全切术用于原发性醛固酮腺瘤手术的疗效

Efficacy of retroperitoneal laparoscopic primary aldosterone adenoma surgery with adrenal-sparing or total adrenalectomy

目的比较后腹腔镜保留正常肾上腺与肾上腺全切术用于原发性醛固酮腺瘤手术的疗效。方法45例原发性醛固酮腺瘤患者行后腹腔镜手术治疗。其中,保留正常肾上腺21例(保留组),肾上腺全切术24例(切除组)。回顾性分析两组患者的临床资料。结果两组手术时间、术中出血量以及术后引流管留置时间、住院时间、血压、血浆醛固酮、血钾和症状缓解率等差异均无统计学意义(P>0.05)。与切除组比较,保留组术后激素替代使用剂量较小[(11.1±1.3)mg/d vs.(13.5±1.7)mg/d],脱离激素替代时间较短[(2.1±0.4)周vs.(4.0±1.1)周](P<0.05)。两组术后随访3个月均无复发。结论后腹腔镜保留正常肾上腺对原发性醛固酮腺瘤手术的疗效与肾上腺全切术相当,但在术后激素替代治疗的需求量和用药时间方面有明显优势。

Objective To compare the efficacy of retroperitoneal laparoscopic primary aldosterone adenoma surgery with adrenal-sparing or total adrenalectomy.Methods Forty-five patients with primary aldosterone adenoma underwent retroperitoneal laparoscopy,in whom adrenal-sparing surgery was used(group A,21 cases)and total adrenalectomy was performed(group C,24 cases).The clinical data of the two groups were analyzed retrospectively.Results There were no significant differences in the operation time,intraoperative bleed loss,postoperative drain indwelling time,hospital stay,blood pressure,plasma aldosterone,blood potassium and symptom relief rate between the two groups(P>0.05).Compared with group C,the postoperative hormone replacement dose was lower[(11.1±1.3)mg/d vs.(13.5±1.7)mg/d],and the time of hormone replacement was shorter in group A[(2.1±0.4)weeks vs.(4.0±1.1)weeks](P<0.05).All the patients were followed up for 3 months without recurrence.Conclusion The efficacy of retroperitoneal laparoscopic primary aldosterone adenoma surgery with adrenal-sparing is comparable to that with total adrenal resection,but has clear advantages in the hormone replacement dose and time for postoperative hormone replacement therapy.