【摘要】 目的观察后腹腔镜保留肾上腺手术治疗醛固酮腺瘤的临床疗效。方法回顾性分析重庆医科大学附属第二医院泌尿外科2014年5月至2018年2月收治的56例原发性醛固酮增多症患者的临床资料,其中34例患者行保留肾上腺手术(保留肾上腺组),22例患者行单侧肾上腺全切术(全切组)。结果 56例患者手术均顺利完成;保留肾上腺组和全切组患者的手术时间[(75.5±10.4) min vs (70.0±9.6) min]、术中出血量[(43.0±7.4) mL vs (40.2±5.5) mL]、拔引流管时间[(2.3±0.9) d vs (2.7±1.1) d]、术后住院时间[(5.8±2.1) d vs (6.4±3.3) d]、病灶大小[(16.4±7.7) mm vs (18.8±4.9) mm]比较差异均无统计学意义(P>0.05);术后随访8～12个月,两组患者在降低血钾、降低血醛固酮、改善血压方面比较差异均无统计学意义(P>0.05);与肾上腺切除组比较,保留肾上腺组患者术后激素替代使用的平均剂量小[(12.03±1.65) mg/d vs (13.12±1.45) mg/d],且脱离激素替代所用时长较短[(4.06±1.43)周vs (7.86±1.72)周],差异均有统计学意义(P<0.05);所有患者随访期间均未复发。结论选择性地对醛固酮腺瘤患者行保留肾上腺的手术,疗效及安全性与行单侧肾上腺切除术相当,且其在术后激素替代过程中有明显优势,值得临床推广。更多还原

【Abstract】 Objective To observe the clinical application of retroperitoneal laparoscopic adrenal-sparing surgery in the treatment of aldosterone-producing adenoma. Methods The clinical data of 56 patients with aldosterone-producing adenoma from May 2014 to February 2018 in the Department of Urology, Second Affiliated Hospital of Chongqing Medical University were analyzed retrospectively, of which 34 patients underwent adrenal-sparing surgery, and 22 patients underwent total adrenalectomy. Results All the 56 patients completed the operation successfully. The two groups showed no statistically significant difference in the following aspects(P>0.05): operation time,(75.5±10.4) min vs(70.0±9.6) min; the intraoperative blood loss,(43.0±7.4) m L vs(40.2±5.5) m L; the drainage tube time,(2.3±0.9) d vs(2.7±1.1) d, postoperative length of hospital stay,(5.8±2.1) d vs(6.4±3.3) d; lesion size,(16.4±7.7) mm vs(18.8±4.9) mm. All the patients were followed up for 8 months to 12 months postoperatively, and all patients did not relapse during the follow-up period. There is no significant differences in reducing blood potassium, reducing blood aldosterone, and improving blood pressure between two groups(P>0.05). Compared with the adrenalectomy group, the adrenal-sparing group had a smaller average dose of hormone replacement and a shorter time period for quitting hormone replacement:(12.03 ± 1.65) mg/d vs(13.12 ± 1.45) mg/d, P<0.05;(4.06 ± 1.43) weeks vs(7.86 ± 1.72) weeks, P<0.05.Conclusion Selective and proper adrenal-sparing surgery for patients with aldosterone-producing adenoma is similar to unilateral adrenalectomy in terms of efficacy and safety. It has obvious advantages in the postoperative hormone replacement process, and is worthy of clinical promotion.更多还原