摘要
目的探讨腹腔镜手术治疗原发性醛固酮增多症（PHA）的临床价值。方法1999年1月至2009年12月，对227例PHA行腹腔镜手术治疗，其中经腹5例，腹膜后222例；男92例，女135例；年龄22～69岁，中位年龄42岁；病程2个月～15年，中位时间4．6年。所有患者术前均有高血压和低血钾病史，血浆醛固酮水平升高伴血浆肾素活性降低。其中醛固酮腺瘤205例，单侧肾上腺皮质增生22例；醛固酮腺瘤中80例行肾上腺全切、125例行肾上腺部分切除术，单侧肾上腺皮质增生采用患侧肾上腺全切手术。结果227例手术均获成功。手术时间15—156min，中位数39min。术中出血量5—220ml，中位数20ml。术后住院时间5～9d，平均（6．9±1．2）d，均恢复顺利。随访6个月～2年，平均1．2年，所有患者血钾恢复正常，180例（80％）血压恢复正常，术后无肾上腺皮质功能不全表现及明显并发症。结论应用腹腔镜行腹膜后肾上腺全切除或部分切除术治疗PHA安全性与疗效肯定。
Objective To evaluate clinical significance of laparoscopic adrenalectomy for treatment of primary aldosteronism. Methods From Jan. 1999 to Dec. 2009, 227 patients （92 males and 135 females） with a confirmed diagnosis of primary aldosteronism underwent laparoscopic adrenalectonly. The median age was 52 years old, ranging from 22 to 69 years old. The median disease duration was 4. 6 yeas, ranging from 2 months to 15 years. 5 cases underwent peritoneal laparoscopic adrenalectomy and 222 cases underwent retroperitoneal lapa- roscopic adrenalectomy. All cases had hypokalemia, hpertension, high plasma aldosterone and low plasma rennin preoperatively. Of all the cases, there were 205 cases with aldosterone-producing adenomas among whom 80 cases underwent total adrenalectomy and 125 cases underwent partial adrenalectomy. There were 22 cases with unilateral adrenal hyperplasia and all of them underwent total unilateral adrenalectomy. Results Procedures were successfully performed in all the 227 cases. The operation duration ranged from 15 to 156 min （39 min as the median） and the blood loss ranged from 5 to 220 ml （20 ml as the median）. The hospitalization time ranged from 5 to 9 days （6. 9 ±1.2 days as the median）. All the cases were followed up from 6 months to 2 years （1.2 years as the medi- an）. Postoperative potassium level resumed normal in all cases. Blood pressure resumed normal in 180 cases （80 % ）. No adrenocortical insufficiency and any other complication occurred. Conclusion Retropreitoneal laparoscopic partial or total adrenalectomy for treatment of primary aldosteronism is a safe and feasible procedure.
出处
《中华内分泌外科杂志》
CAS
2011年第2期117-119,共3页
Chinese Journal of Endocrine Surgery
