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目的探讨经腹腔途径腹腔镜单侧肾上腺切除术治疗肾上腺结节样增生性原发性醛固酮增多症的效果。方法 2004年4月至2010年8月间,我科共收治114例肾上腺结节样增生性原发性醛固酮增多症患者,其中105例为单侧,9例为双侧,均行经腹腔途径腹腔镜单侧肾上腺切除术。回顾性分析患者的临床资料,并随访其术后血压恢复情况及血浆醛固酮、血钾的变化。结果所有手术均获成功,无中转开放手术患者。平均手术时间为(32.4±8.3)min,平均术中出血量为(10.5±5.2)mL,平均术后住院时间(7.9±3.1)d,术中及术后无重大并发症。术后病理均为肾上腺结节样增生,结节大小在2～16 mm间。在中位时间为31(6～82)个月的随访期内,55例(48.2%)患者高血压治愈,57例(50%)改善,2例(1.8%)无效,1例患者术后醛固酮仍高出正常,其余患者的血浆醛固酮及血钾均在正常范围内。结论腹腔镜单侧肾上腺切除术是治疗肾上腺结节样增生性原发性醛固酮增多症的一种安全、有效的方法。
Objective To investigate the effect of transperitoneal laparoscopic unilateral adrenalectomy on adrenal nodular hyperplasia of primary aldosteronism. Methods From April 2004 to August 2010, 114 patients with adrenal nodular hyperplasia of primary aldosteronism were treated in our department. One hundred and five patients were unilateral and nine patients were bilateral. All patients underwent transabdominal abdominal cavity Unilateral adrenalectomy. The clinical data of patients were retrospectively analyzed. The postoperative blood pressure recovery and the changes of plasma aldosterone and serum potassium were also analyzed. Results All the operations were successful and there was no transfer of open surgery patients. The mean operative time was (32.4 ± 8.3) min. The mean intraoperative blood loss was (10.5 ± 5.2) mL. The average postoperative hospital stay was (7.9 ± 3.1) days. There were no major complications during and after operation. Postoperative pathology were adrenal nodular hyperplasia, nodule size of 2 ~ 16 mm. During a median follow-up of 31 (6 to 82) months, 55 (48.2%) patients were cured of hypertension, 57 (50%) were improved, 2 (1.8%) were ineffective, and 1 Aldosterone is still higher than normal, the remaining patients with plasma aldosterone and serum potassium are in the normal range. Conclusion Laparoscopic unilateral adrenalectomy is a safe and effective method for the treatment of adrenal nodular hyperplasia of primary aldosteronism.