朱平

[摘 要] 目的：观察醛固酮腺瘤和单侧肾上腺增生导致醛固酮增多症腹腔镜手术效果。方法：以我院2013年3月—2014年3月收治的50例醛固酮增多症患者为研究对象，醛固酮腺瘤组38例、单侧肾上腺增生组12例，均行腹膜后腹腔镜手术，肿瘤体积较大且与周围组织界限清晰者行肾上腺部分切除，其他患者行肾上腺全切。观察围术期指标及术后症状变化，比较肾上腺部分切除与肾上腺全切手术情况。随访1年，比较疗效及复发情况。结果：肾上腺全切的醛固酮腺瘤手术时间显著高于肾上腺部分切除的醛固酮腺瘤及单侧肾上腺增生，差异有统计学意义（P<0.05），各组患者术中出血量、术后住院时间比较，差异无统计学意义（P>0.05）。2组患者术后1个月收缩压、舒张压、血浆醛固酮、醛固酮/肾素比值均显著降低，血钾、血浆肾素活性均显著升高，与术前比较差异有统计学意义（P<0.05）。患者术后1年均未见复发，单侧肾上腺增生、肾上腺全切醛固酮腺瘤、肾上腺部分切除醛固酮腺瘤治愈率分别为66.7%、64.7%、61.9%，组间比较差异无统计学意义（P<0.05）。结论：腹腔镜手术治疗醛固酮增多症两种亚型均有良好的疗效及安全性，对符合肾上腺部分切除指征患者，术中应尽可能保留患侧肾上腺组织。

[关键词] 醛固酮腺瘤；单侧肾上腺增生；醛固酮增多症；腹腔镜

中图分类号：R737.11 文献标识码：B 文章编号：2095-5200（2016）04-044-03

DOI：10.11876/mimt201604017

Comparison of the effects of laparoscopic surgery in treatment of aldosteronism caused by aldosterone adenoma and unilateral adrenal hyperplasia ZHU Ping. （Department of general surgery，Xian Fifth Hospital，Xian 710082，China）

[Abstract] Objective： To observe the effects of laparoscopic surgery in treatment of aldosteronism caused by aldosterone adenoma and unilateral adrenal hyperplasia. Methods： 50 cases of patients with aldosteronism treated in our hospital from March 2013 to March 2014 were chosen for this study， 12 cases included in unilateral adrenal hyperplasia group and 38 cases in aldosterone adenoma group， both groups underwent retroperitoneal laparoscopic surgery， the patients with larger tumor volume and well-circumscribed surrounding tissues underwent partial adrenalectomy， others with total adrenalectomy. Perioperative indexes and postoperative change in symptoms were observed， the conditions of patients with partial adrenalectomy and total adrenalectomy were compared. With1-year follow-up， the efficacy and recurrence were compared between two groups. Results： The operation time of aldosterone adenoma with total adrenalectomy was significantly higher than those of aldosterone adenoma and unilateral adrenal hyperplasia with partial adrenalectomy， the differences were statistically significant （P<0.05）， the amount of bleeding and postoperative hospital stay were compared between two groups， the differences were not statistically significant （P>0.05）. The ratios of systolic blood pressure， diastolic blood pressure， plasma aldosterone to renin of two groups at 1 months after surgery were significantly increased， serum potassium and plasma renin activity were significantly elevated compared with the preoperative indexes， the differences were statistically significant （P<0.05）. No recurrence was found in all the patients， cure rates of unilateral adrenal hyperplasia， aldosterone adenomas with total adrenalectomy， aldosterone adenoma with partial adrenalectomy were 66.7%， 64.7%， 61.9%， respectively， the intergroup differences were not statistically significant （P<0.05）. Conclusions： Laparoscopic surgery has good efficacy and safety in the treatment of two subtypes of aldosteronism， and ipsilateral adrenal tissue should be retained as far as possible in the surgery as for patients meeting the indications of partial adrenalectomy.

[Key words] aldosterone adenoma；unilateral adrenal hyperplasia；hyperaldosteronism；laparoscopy

原发性醛固酮增多症主要包括两种亚型，即醛固酮腺瘤和结节性肾上腺增生，均由肾上腺皮质球状带病变引发[1]。该病是高血压罕见但重要的致病因素之一，手术是主要治疗方法。近年来，腹腔镜手术在原发性醛固酮增多症治疗中应用逐渐广泛[2-3]。为观察腹腔镜手术对醛固酮增多症两种亚型的治疗效果，以我院2013年3月—2014年3月收治的50例醛固酮增多症患者为研究对象，进行回顾性分析，现将手术方法与治疗效果总结如下。

1 一般资料

所有患者均接受腹膜后入路腹腔镜手术治疗，行肾上腺全切或肾上腺部分切除，病例及随访资料保存完整。……