基于CT影像的手术决策治疗单侧醛固酮腺瘤疗效研究

Effect of surgical decision based on computed tomography on patients with unilateral aldosterone-producing adenoma

目的:单侧肾上腺病变的原发性醛固酮增多症(primary aldosteronism,PA)可通过肾上腺切除术治愈或改善。目前指南推荐肾上腺静脉采血(adrenal venous sampling,AVS)作为诊断金标准。基于计算机断层扫描(CT)影像的手术决策仅被推荐用于年龄<35岁的单侧腺瘤患者。本研究旨在比较不同年龄组的单侧醛固酮腺瘤患者基于CT或AVS手术的疗效。方法:回顾性分析2018年6月—2021年1月在上海交通大学医学院附属瑞金医院因PA行单侧肾上腺切除术的178例患者的临床资料,根据决定手术的方式,分为CT组(54例)及AVS组(124例)。经过1年的随访,根据原发性醛固酮增多症手术结局(primary aldosteronism surgical outcome,PASO)标准评估术后临床和生化缓解率。结果:CT组与AVS组完全临床缓解率(46.3%vs 47.6%,P=0.875)和完全生化缓解率(88.8%vs 91.9%,P=0.515)比较,差异均无统计学意义。结论:这项研究表明,基于CT影像决策的手术可能适用于年龄范围更广的单侧醛固酮腺瘤患者。而对于双侧肾上腺正常或双侧肾上腺病变的PA患者,AVS仍是必需的诊断标准。

Objective:Primary aldosteronism(PA)with unilateral adrenal disease can be cured or improved by adrenalectomy.Guidelines recommend adrenal venous sampling(AVS)to identify patients for surgical manage-ment.Currently,surgeries based on computed tomography(CT)images are only recommended for PA patients aged<35 years with visible unilateral adenoma.We aimed to compare the outcomes between CT-based surgery and AVS-based surgery for PA patients with visible unilateral adenoma among different age groups.Methods:A cohort study of 178 PA patients who underwent unilateral adrenalectomy at Ruijin hospital between June 2018 and January 2021 was conducted.Patients were grouped retrospectively according to how surgical decisions were made,CT group(54 cases)and AVS group(124 cases).Clinical and biochemical outcomes were analyzed accord-ing to primary aldosteronism surgical outcome(PASO)criteria after 1 year follow-up.Results:The complete clini-cal success(46.3%vs 47.6%,P=0.875)and complete biochemical success(88.8%vs 91.9%,P=0.515)were similar between CT group and AVS group.Conclusion:Surgery based on CT images might be feasible for PA pa-tients with visible unilateral adenoma,while for PA patients with normal adrenal or bilateral adrenal lesions,the right treatment strategy would be obtained by the AvS.