【作者】 张勇辉；

【导师】 金讯波；

【作者基本信息】 山东大学 ， 泌尿外科， 2008， 硕士

【摘要】 目的:探索原发性醛固酮增多症一侧肾上腺皮质单发腺瘤与多发腺瘤的临床表现、高血压情况、实验室检查、病理表现、治疗效果等的区别。方法:选取我中心2005年10月至2007年10月腹腔镜手术治疗的80例原发性醛固酮增多症患者,A组39例一侧肾上腺皮质单发腺瘤和B组41例多发腺瘤的高血压患者,通过分析患者术前术后血压、临床症状、实验室检查、B超和CT等影像学检查结果,探索一侧肾上腺皮质单发腺瘤与多发腺瘤的临床表现、高血压情况、实验室检查、病理、治疗效果等的区别。术后1个月、3个月、6个月、12个月分别随访一次,观察患者相应症状改善情况。结果:一侧肾上腺皮质单发腺瘤与多发腺瘤相比较,单发腺瘤平均直径(平均直径2.13±0.86cm)大于多发腺瘤最大腺瘤的平均直径(平均直径1.69±0.73cm)(P＜0.05);单发腺瘤组平均最低血钾(血钾平均为2.98±0.86mmol/l)小于多发腺瘤组(血钾平均为3.54±0.76mmol/l)(P＜0.05);一侧肾上腺单发腺瘤组与多发腺瘤组相比较,术前血压、醛固酮、A1、A2均无明显差别(P＞0.05);A、B两组共80例患者均顺利完成腹腔镜手术,均未发生手术并发症,术后7～9天出院;术后第1、3、6、12个月随访,A、B两组在高血压、四肢乏力等症状均有明显改善。结论:、一侧肾上腺皮质单发腺瘤与多发腺瘤相比较,两组病理无特异性差别;一侧肾上腺皮质多发腺瘤在腺瘤型原发性醛固酮增多症中发病率高;腹腔镜患侧肾上腺全部切除术是一侧肾上腺腺瘤型原发性醛固酮增多症有效治疗手段。更多还原

【Abstract】 OBJECTIVE: Explore the differences of clinical manifestation,blood pressure, laboratory tests,treatment etc. between the unilateral adrenal cortical single adenoma and unilateral adrenal cortical multiple adenoma.METHODS: The clinical data of 39 cases of the unilateral adrenal cortical single adenoma and 41 cases of unilateral adrenal cortical multiple adenome from 2005 to 2007 were retrospectively analyzed. Blood pressure,clinical manifestation, laboratory tests of preoperation and postoperation ,imaging examination results,pathological outcomes were analyzed.RESULTS: The adenoma -diameter of group A (an average diameter of 2.13±0.86cm)is larger than the maximum diameter of the largest tumor in group B(an average diameter of 1.69±0.73cm)(P<0.05). Moreover,the serum potassium level of group A(an average potassium of 2.98±0.86mmol/l) is lower than group B(an average potassium of 3.54±0.76mmol/l)(P<6>.05). All patients underwent laparoscopic adrenalectomy,with no operative complication happened. After statistical analysis,blood pressure and serum potassium had improved significantly(P<0.05). CONCLUSIONS: Compared the unilateral adrenal cortical single adenoma and unilateral adrenal cortical multiple adenoma,the difference of pathology are not significant. The incidence of unilateral adrenal cortical multiple adenoma is high in the adenomatoid primary aldosteronism. Laparoscopic adrenalectomy is the best treatment of the unilateral adrenal cortical single adenoma and unilateral adrenal cortical multiple adenoma.更多还原