原发性醛固酮增多症的手术治疗

Surgical Operation of Primary Aldosteronism

目的 探讨原发性醛固酮增多症 (PA)的手术适应证及疗效影响因素。方法 分析 83例不同类型PA的临床特点。 6 9例行手术治疗。对手术病例的选取原则、手术方式、病理特点及对疗效的影响进行评价。结果 随访手术病例 5 9例 ,血钾恢复正常率 93.2 % ,高血压治愈率 5 5 .9% ,缓解率 33.9% ,手术无效率 10 .2 %。治愈组血浆肾素水平 (PRA)正常率 12 .1% ,持续高血压组为 38.5 % ,两组差异有显著意义 (P <0 .0 5 ) ;治愈组高血压病程 4 .1年 ,持续高血压组 7.5年 (P <0 .0 5 )。醛固酮瘤 (APA)行部分肾上腺切除 14例 ,患侧肾上腺切除 2 8例 ,总有效率分别为 92 .9%和 96 .4 % ,两组差异无显著意义 (P >0 .0 5 )。结论 对过度分泌醛固酮的单侧肾上腺结节性病灶 ,均应手术切除。单个腺瘤型APA可行部分肾上腺切除 ,多发性APA或肾上腺增生应行肾上腺全切除。术式选择不当、病灶切除不彻底或复发 ,以及病程长。

Purpose: To study the surgical indications and factors associated with normolization of blood pressure (BP) after surgery of primary aldosteronism(PA). Methods: Clinical features of 83 cases of different types of PA were analysed. Sixty nine cases accepted adrenalectomy or partial adrenalectomy. Surgical indications, patterns, and pathological features associated with results were evaluated. Results: Fifty nine surgical cases were followed. Fifty five cases (93.2%) had normal serum potassium level; BP was normalized in 33 cases (55.9%; Hypertension persisted but BP control was significantly improved in 20 cases (33.9), and not improved in the remaining 6 patients (10.2%). The rate without suppressed PRA was 12.1% (4/33) in normal BP group, and 38.5% (10/26) in remained hypertension group (P 0.05). Conclusions: Patients with unilateral overproduction of aldosterone who potentially can be cured surgically. Patients presented with a single adrenal adenomas can be treated by partial adrenalectomy, those with multiple adenomas or hyperplasia should accepted adrenalectomy. The factors related with surgical effect included durations of hypertension, secondary hypertensive kidney damage, and insufficient surgery or recurrence.