原发性醛固酮增多症的手术治疗

目的探讨原发性醛固酮增多症（PA）的手术适应证及疗效。方法分析26例不同类型PA的临床特点,18例行手术治疗,对手术病例的选取原则、手术方式及疗效进行评价。结果随访手术病例18例,随访期间2例APA和1例IHA仍有低血钾,其余15例（83.3%）血钾恢复正常。手术后不需再用降压药物12例,治愈率66.7%;血压明显改善者5例,缓解率27.8%;手术无效、血压未改善者1例（5.5%）。随访病例中,开放手术13例,腹腔镜手术5例,两组总有效率差异无显著意义。结论对过度分泌醛固酮的单侧肾上腺结节性病灶,均应手术切除;单个腺瘤型APA可行部分肾上腺切除;多发性APA或肾上腺增生应行肾上腺全切除。腹腔镜手术正成为治疗PA的新方法。

Surgical treatment of primary aldosteronism

ObjectiveTo evaluate the clinical results of surgical treatment for primary aldosteronism(PA).MethodsThe clinical features of 26 cases of different types of PA were analysed.Among them,18 cases received surgical treatment.We evaluated its surgical indications,surgical patterns,pathological features,and outcomes.ResultsAll the 18 patients undergoing operation were followed up,in whom 15 patients(83.3%) restored a normal serum potassium level,12 cases terminated using hypotensive drugs after operation(66.7%),and 5.5% patients' blood pressure failed to improve.There was no significant difference in effective rate no matter translaparoscopic surgical approach or conventional operation was adopted(P>0.05).ConclusionFor the treatment of primary aldosteronism,partial or complete surgical resection is still an effective alternative of treatment.Laparoscopic operation is becoming a new and an important therapeutic approach.