肾上腺结节样肿物并发难治性高血压的手术治疗(附67例报告)  

The surgical correction of refractory hypertension complicated with adrenal hyperplasia and adenoma in 67 cases

作　　者：刘谦[1] 马洪顺[1] 白志杰[1] 刘光明[1] 姚世杰[1] 吴建辉[1] 范玉铃[1] 

机构地区：[1]天津市第一中心医院泌尿外科,300192

出　　处：《北京医学》2012年第5期356-358,共3页Beijing Medical Journal

摘　　要：目的探讨肾上腺结节样肿物合并难治性高血压的诊断与外科治疗经验。方法总结67例肾上腺结节样肿物合并难治性高血压患者的发病年龄、临床表现、相关内分泌检查、影像与病理特点以及手术治疗后的相关变化。本组67例,年龄28～63岁,平均37.8岁,均有高血压病史,平均收缩压(196±33)mmHg,平均舒张压(127±15)mmHg。病程5～240个月,平均65.2个月。肾上腺结节样肿物位于左侧37例,右侧26例,双侧4例。血K+﹤3.5mmol/L者43例。肾素-血管紧张素-醛固酮(ACTH)异常60例,3-甲氧基4-羟基扁桃酸(VMA)异常24例,7例内分泌学的检查均正常。CT或MRI显示肾上腺结节样肿物直径0.3～2.0cm。结果本组患者均行腹腔镜患侧肾上腺结节样肿物切除、肾上腺部分切除术或全部切除治疗。病理检查肾上腺皮质结节样增生28例,肾上腺皮质腺瘤39例。术后血钾、24h尿钾、血肾素醛固酮均恢复正常,术后6个月肾上腺皮质腺瘤组平均收缩压为(127±11)mmHg、平均舒张压为(80±7)mmHg,肾上腺皮质增生组平均收缩压为(135±12)mmHg、平均舒张压为(90±9)mmHg,较术前均有明显下降。结论利用腹腔镜手术行患侧肾上腺部分切除术或全部切除治疗肾上腺结节性肿物合并难治性高血压是安全、可行和有效的方法。Objective To evaluate surgical treatment experiences of refractory hypertension complicated with adrenal hyperplasia and adenoma. Methods Sixty-seven cases which confirmed adrenal hyperplasia and adenoma were reviewed and summarized retrospectively including clinical endocrinological and imaging findings, pathological characteristics, treatment and prognosis. There were 28 males and 39 females with an average age of 37.8 years old. Thirty-dseven cases had left adrenal problem and 26 cases had right adrenal abnormalities and 2 cases had bilateral adrenal problems. All patients were demonstrated to have hypertension without any Cushing＇s symptoms.The laboratory examination showed 43 cases with low potassium plasma levels （〈3.5 mmol/L）. The tests of rennin-angiotensin-aldosterone system were abnormal in 60 Cases. The endocrinological tests were normal in 7 cases. Nodules of adrenal glands were found in 67 cases by CT or MR imaging. Results All patients underwent unilateral laparoscopic adrenoectomy, subtotal adrenoectomy or adenomaeetomy. No surgery related morbidity occurred. The duration of follow-up of 67 cases ranged from 24 to 48 months, the BP levels of all patients significantly decreased 3-6 month after operation, and the remaining 3 patients had decreased antihypertensive treatment medications. The tests of rennin-angiotensin-aldosterone and serum potassium level were normal. There was no cases suffered from adrenal gland hypofunction. Conclusion Unilateral laparoscopic adrenaoectomy and adenoma-ectomy of adrenal gland are effective and safe treatment for refractory hypertension complicated with adrenal hyperplasia and adenoma. Long-term BP control could be achieved and patient＇s quality of life is improved.

关 键 词：肾上腺 切除术 高血压 结节样 

分 类 号：R544.1[医药卫生—心血管疾病]