后腹腔镜下肾上腺部分与全部切除术治疗单侧醛固酮腺瘤的对比研究  

Retroperitoneal Laparoscopic Partial Versus Total Adrenalectomy for Unilateral Aldosterone-producing Adenoma

作　　者：薛永平[1] 肖维仁 王敏捷[1] 胡卫列[1] 

机构地区：[1]第二军医大学广州临床医学院广州军区广州总医院泌尿外科,广州510010

出　　处：《中国微创外科杂志》2017年第3期209-212,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：国家自然科学基金(项目编号:81172421)

摘　　要：目的比较后腹腔镜下肾上腺部分切除(partial adrenalectomy,PA)与全部切除(total adrenalectomy,TA)治疗单侧醛固酮腺瘤(aldosterone-producing adenoma,APA)的疗效。方法 2006年1月~2012年12月,47例单侧APA接受手术治疗,其中36例行后腹腔镜下肾上腺部分切除术(PA组),11例行后腹腔镜下肾上腺全部切除术(TA组),比较2组患者术后血浆醛固酮浓度、血钾水平、血压水平、服用降压药物种类。结果均无术中输血及中转开腹。PA组和TA组手术时间分别为(116.5±37.0)、(100.2±42.8)min,无统计学差异(t=1.233,P=0.224);术中出血量中位数分别为30 ml(5~400 ml)、20 ml(10~300 ml),差异无统计学意义(Z=-1.267,P=0.205);禁食时间分别为(1.7±0.7)、(1.7±0.6)d,差异无统计学意义(t=0.000,P=1.000);拔引流管时间分别为(3.0±0.8)、(2.8±0.9)d,差异无统计学意义(t=0.705,P=0.484);术后住院时间分别为(8.2±2.2)、(8.1±2.0)d,差异无统计学意义(t=0.135,P=0.894)。47例随访6~97个月(平均30个月),术后均无复发,无须补充血钾;2组患者高血压治愈率、改善率、无效率分别为(61.1%、25.0%、13.9%)和(63.6%、36.4%、0),差异无统计学意义(Z=-0.437,P=0.662)。结论对单侧肾上腺APA的手术治疗,后腹腔镜下PA技术上安全可行,疗效等同TA。Objective To compare clinical effects between retroperitoneal laparoscopic partial and total adrenalectomy for unilateral aldosterone-producing adenoma（ APA）. Methods From January 2006 to December 2012,47 patients with unilateral APA were treated by surgery,including 36 cases of retroperitoneal laparoscopic partial adrenalectomy（ PA group） and 11 cases of total adrenalectomy（ TA group）. A retrospective comparison about postoperative outcomes such as postoperative serum aldosterone,potassium level,blood pressure and number of antihypertensive drugs was performed between the two groups. Results There were no blood transfusions or conversions to open surgery. There were no differences in terms of operative time,blood loss,time for dieting,extubation time and postoperative hospital stay between the PA group and TA group [（ 116. 5 ± 37. 0） min vs.（ 100. 2 ± 42. 8） min,t = 1. 233,P = 0. 224; median 30 ml（ 5-400 ml） vs. 20 ml（ 10-300 ml）,Z =-1. 267,P = 0. 205;（ 1. 7 ± 0. 7） d vs.（ 1. 7 ±0. 6） d,t = 0. 000,P = 1. 000;（ 3. 0 ± 0. 8） d vs.（ 2. 8 ± 0. 9） d,t = 0. 705,P = 0. 484;（ 8. 2 ± 2. 2） d vs.（ 8. 1 ± 2. 0） d,t =0. 135,P = 0. 894]. Follow-ups for 6-97 months（ mean,30 months） found no recurrences and no requirements of potassium supplement. The two groups＇ curative rates,improvement rates and ineffective rates were（ 61. 1%,25. 0%,13. 9%） vs.（ 63. 6%,36. 4%,0）,respectively,without significant differences between them（ Z =-0. 437,P = 0. 662）. Conclusion For the surgical treatment of patients with unilateral APA,retroperitoneal partial adrenalectomy is technically safe and feasible,with clinical effects equal to retroperitoneal total adrenalectomy.

关 键 词：原发性醛固酮增多症 醛固酮腺瘤 后腹腔镜 肾上腺部分切除术 肾上腺全部切除术 

分 类 号：R699.3[医药卫生—泌尿科学]