肾上腺腺瘤型原发性醛固酮增多症149例

目的提高肾上腺腺瘤型原发性醛固酮增多症(简称原醛症 )的诊治水平. 方法回顾性分析1978～2001年2月收治的149例经手术和病理证实的肾上腺腺瘤型原醛症患者诊断治疗及预后的临床资料. 结果腹膜后充气造影、B超和CT在肾上腺腺瘤型原醛症诊断中的特异性分别为39.0%、67.0%和95.3%,腹膜后充气造影与B超和CT诊断特异性比较,差异有显著意义(χ2=23.89,P＜0.01),B超与CT诊断特异性比较差异有显著意义(χ2=32.10,P＜0.01).术后1个月所有患者血钾恢复正常,术后2个月内11 0例(73.8%)患者血压恢复正常. 结论 B超和CT检查是肾上腺腺瘤型原醛症定位诊断的主要方法,手术是主要的治疗手段,腹腔镜肾上腺切除术是一种很有前途的治疗方法.影响疗效的因素,主要与患者年龄大、病史长、全身血管硬化有关.     

后腹腔镜治疗肾上腺醛固酮腺瘤349例

目的:评估后腹腔镜技术治疗肾上腺醛固酮瘤的效果.方法:对349例肾上腺醛固酮瘤患者施行后腹腔镜手术.结果:341例完成手术,8例中转开放手术,无严重并发症发生.术后随访6～36个月,血钾均恢复正常,112例仍有高血压需辅以降压药物治疗.结论:后腹腔镜技术治疗肾上腺醛固酮瘤,安全、有效,可作为首选治疗方案.     

腹膜后腹腔镜手术治疗原发性醛固酮增多症130例

目的　探讨腹膜后腹腔镜手术治疗原发性醛固酮增多症的临床价值。方法2 0 0 0年 2月到 2 0 0 3年 9月 ,我院对 130例 (男 5 4例 ,女 76例 )原发性醛固酮增多症患者行腹膜后腹腔镜手术治疗 ,其中肾上腺皮质腺瘤 119例 ,特发性肾上腺皮质增生 11例 (其中 2例为单侧皮质增生 ) ;肾上腺皮质腺瘤中 6 1例行肾上腺全切、5 8例行肾上腺部分切除术 ,肾上腺皮质增生采用单侧肾上腺全切手术。所有病例术前均有高血压和低血钾表现 ,及血浆醛固酮水平升高伴血浆肾素活性降低。结果　 130例手术均获得成功。手术时间 15～ 2 2 5min ,中位数为 4 3min ;术中出血量 0～ 2 0 0ml(出血量小于 5ml计出血量为 0 ) ,中位数为 2 0ml;术后住院时间 3～ 9d ,平均 (5 1± 1 3)d。所有病例术后 1个月内血钾恢复正常 ,醛固酮 /肾素比值明显降低 ,在未用降压药物情况下 ,88例 (6 8% )术后 2个月内血压恢复正常。随访 82例 ,6个月至 2年无明显并发症。结论　应用腹腔镜行腹膜后肾上腺全切除或部分切除术治疗原发性醛固酮增多症安全、可行。     

双侧肾上腺皮质腺瘤致原发性醛固酮增多症二例报告

双侧肾上腺皮质腺瘤致原发性醛固酮增多症临床罕见，我院收治2例。现报告如下。     

原发性醛固酮增多症的后腹腔镜治疗

目的：探讨腹膜后腹腔镜治疗原发性醛固酮增多症（primary aldosteronism,PHA）的应用。方法：2002年1月-2009年1月,我院对211例（男109例,女102例）PHA患者行腹膜后腹腔镜手术治疗,其中肾上腺醛固酮腺瘤（APA）113例,单侧肾上腺增生（UNAH）62例,特发性醛固酮增多症（IHA）36例。结果：211例手术均获得成功,无严重并发症发生,手术时间35～360（119．32±58．65）min,出血量10～200（52．85±49．41）ml,住院天数5～14天,术后随诊1～7（2．50±1．58）年,血压恢复正常73例,血压明显改善83例,55例患者术后仍存在高血压,总改善率为74％。结论：应用后腹腔镜治疗PHA安全、有效。     

腺瘤型原发性醛固酮增多症临床延迟诊断原因分析

目的 探讨肾上腺腺瘤型原发性醛固酮增多症(原醛症)发病特点和临床延迟诊断的可能原因.方法 腺瘤型原醛患者118例,发病年龄(37.3±8.4)岁,确诊年龄(44.5±10.1)岁.原发性高血压病患者46例作为对照,年龄(45.6±14.2)岁.比较2组患者病程、夜/昼尿量比、血浆肾素活性、血浆醛固酮浓度、卧立位醛固酮试验、立位醛固酮/肾素比值等指标,分析原醛症延迟诊断原因.结果 原醛症患者血钾浓度(2.65:0.7)mmol/L、尿钾浓度(56.04±31.2)mmol/24 h、立位血浆肾素活性(2.1±1.2)μg·L-1·h-1、血浆醛固酮浓度(840.5±527.1)pmol/L、立位醛固酮/肾素比值254.2±153.4,原发性高血压病患者分别为(3.9±0.5)mmol/L、(13.0±5.3)mmol/24 h、(9.3±3.4)μg·L-1·h-1、(393.9±216.4)pmol/L、23.9±15.5,组间比较差异均有统计学意义(P相似文献   

腹腔镜手术治疗原发性醛固酮增多症227例

Objective To evaluate clinical significance of laparoscopic adrenalectomy for treatment of primary aldosteronism.Methods From Jan.1999 to Dec.2009,227 patients(92 males and 135 females)with a confirmed diagnosis of primary aldosteronism underwent laparoscopic adrenalectomy.The median age was 42years old,ranging from 22 to 69 years old.The median disease duration was 4.6 yeas,ranging from 2 months to 15 years.5 cases underwent peritoneal laparoscopic adrenalectomy and 222 cases underwent retropefitoneal laparoscopic adrenalectomy.All cases had hypokalemia,hpertension,high plasma aldosterone and low plasma rennin preoperatively.Of all the cases,there were 205 cases with aldosterone-producing adenomas among whom 80 cases underwent total adrenalectomy and 125 cases underwent partial adrenalectomy.There were 22 cases with unilateral adrenal hyperplasia and all of them underwent total unilateral adrenalectomy.Results Procedures were successfully performed in all the 227 cases.The operation duration ranged from 15 to 156 min(39 min as the median)and the blood loss ranged from 5 to 220 ml(20 ml as the median).The hospitalization time ranged from 5 to 9 days (6.9±1.2 days as the median).All the cases were followed up from 6 months to 2 years(1.2 years as the median).Postoperative potassium level resumed normal in all cases.Blood pressure resumed normal in 180 cases(80%).No adrenocortieal insufficiency and any other complication occurred.Conclusion Retropreitoneal laparoscopic partial or total adrenalectomy for treatment of primary aldosteronism is a safe and feasible procedure.     

原发性醛固酮增多症的诊断与治疗(附28例报告)

目的:探讨原发性醛固酮增多症(PA)的诊断和治疗。方法:分析1988～1997年外科治疗的PA28例,其中肾上腺皮质腺瘤25例,肾上腺皮质增生3例。结果:25例肾上腺皮质腺瘤患者全部治愈,3例肾上腺皮质增生患者术后仍需服用安体舒通治疗。结论:安体舒通试验、血醛固酮测定是PA的主要定性诊断方法,血醛固酮体位试验和影像学检查有助于肾上腺皮质腺瘤和增生的鉴别;PA的定位诊断主要依靠B超和CT检查,其准确率分别为80%和100%。外科手术是治疗PA的重要方法。     

腹腔镜肾上腺切除术治疗原发性醛固酮增多症合并2型糖尿病患者的临床研究

目的探讨腹腔镜肾上腺切除术治疗合并2型糖尿病的原发性醛固酮增多症患者的临床效果。方法回顾性分析自2013年1月至2013年12月间本单位收治的11例合并2型糖尿病的肾上腺醛固酮瘤(APA)所致原醛症患者,接受腹腔镜患侧肾上腺切除手术前后醛固酮、血压、空腹血钾、空腹血糖的变化情况。结果醛固酮、血压、空腹血糖在术后明显下降,血钾水平明显上升至正常水平(P0.05)。结论伴2型糖尿病的APA所致原醛症患者行腹腔镜患侧肾上腺切除手术后高血压、低血钾、高血糖得到纠正,可改善该类型患者胰岛素抵抗现象。     

外科治疗原发性醛固酮增多症15例报告

报告手术治疗原发性醛固酮增多症15例,其中腺瘤14例,结节性增生1例。15例均有高血压,14例血钾低于3mmol/L,24小时尿钾均增高。采用B超和CT作定位诊断,符合率均为92.3%。并对本病的诊断和治疗的有关问题进行了讨论。     

肾上腺微小病灶的后腹腔镜手术

目的 总结直径≤1.5 cm的肾上腺微小病灶后腹腔镜下手术切除要点及体会.方法 后腹腔镜下肾上腺微小病灶部分切除术患者52例,其中原发性醛固酮增多症46例(皮质腺瘤36例,皮质增生10例)、无功能腺瘤3例、髓样脂肪瘤、肾上腺转移癌、混合瘤各1例.病灶位于右侧27例,左侧25例.超声和CT检查病灶直径平均1.2(0.8～1.5)cm.于肾脏内上方、近后腹膜处分离肾上腺,先游离寻找靠近后腹膜的肾上腺内侧肢,并充分游离出整个肾上腺组织.结果 52例病灶均完整切除,术后均经组织病理学证实.手术时间平均92(35～240)min.出血量平均150(30～260)ml.无输血病例.术中术后无明显并发症.术后需镇痛处理8例.术后平均16(12～24)h恢复肠道功能.术后住院时间平均4.6(3～9)d.超声检查对病灶的定位准确率71%(37/52)、CT检查为96%(50/52).结论 CT检查对肾上腺微小病灶的定位准确率高,腹腔镜下充分游离寻找靠近后腹膜的肾上腺内侧肢、探查整个肾上腺组织是手术成功的关键.     

后腹腔镜肾上腺肿瘤剜除术的临床观察

目的:评价后腹腔镜肾上腺部分切除、肿瘤剜除以及肾上腺切除手术的临床效果,确定治疗肾上腺单发良性功能性腺瘤的最佳手术方式。方法:回顾性分析53例肾上腺单发良性功能性腺瘤患者手术后血压、血电解质、醛固酮浓度和局部肿瘤复发情况,其中15例行单侧肾上腺切除术,6例行部分肾上腺切除术,32例行肾上腺肿瘤剜除术。结果:手术后平均随访2.5年,三种不同手术方式均可改善肾上腺单发良性功能性腺瘤的临床表现;3个月后,除3例仍有高血压外,三组的血电解质、醛固酮浓度、皮质醇浓度均恢复正常,无一例肿瘤复发,各组间差异无统计学意义(P>0.05);单侧肾上腺切除和部分肾上腺切除的手术时间显著大于肿瘤剜除术(P<0.05)。结论:虽然三种不同手术方式均为肾上腺肿瘤的有效治疗方法,但后腹腔镜肾上腺肿瘤剜除术既能缩短手术时间,又能保留同侧肿瘤外的肾上腺组织和功能,应为肾上腺单发良性功能性腺瘤的最佳手术方式。     

两种类型原发性醛固酮增多症的手术疗效分析

目的 探讨原发性醛固酮增多症(PHA)中醛固酮腺瘤(APA)和单侧肾上腺增生(UNAH)2种亚型的临床特点、手术效果及影响术后血压恢复的因素. 方法 2002-2009年资料完整的手术治疗PHA患者135例.男68例,女67例.平均年龄51(26～79)岁.其中APA 83例,UNAH 52例.135例均符合PHA诊断标准,术前均有高血压症状,术前均行血液激素、生化检查及CT等影像学检查,并经病理和随访证实.135例均行保留肾上腺手术(ASS).Logistic回归分析各项临床病理因素对术后血压的影响. 结果 135例手术均成功.术后平均随访2.5(1～7)年.与术前比较,术后收缩压及舒张压显著降低,降压药物使用量明显减少,血醛固酮、肾素活性、血钾指标明显改善.血压恢复正常51例(37.8%);术后血压仍高84例(62.2%),其中58例降压药物使用剂量减少.年龄＞49.5岁、高血压病程＞6.5年、有高血压家族史者术后持续高血压的风险增加.结论 APA和UNAH患者表现相似,手术效果好,ASS手术可作为首选治疗方案.年龄、高血压病程、高血压病家族史是影响术后血压变化的重要因素.     

Hazards of laparoscopic adrenalectomy for Conn's adenoma

A 74-year-old man with primary aldosteronism had a small tumor (27 × 23 mm) of his right adrenal gland successfully removed by a transperitoneal laparoscopy. Despite absence of malignancy in the resected tumor and complete relief of all symptoms in the immediate postoperative period, recurrence occurred 6 months later. The tumor behaved as a carcinoma spread in the peritoneal cavity, and the patient eventually died with peritoneal carcinomatosis. We suggest that the laparoscopic technique coupled with pneumoperitoneum may have favored this recurrence. Received: 7 September 1998/Accepted: 12 February 1999     

腹腔镜行肾上腺部分切除术与全切术治疗肾上腺原醛瘤的比较:附235例报告

目的 探讨肾上腺部分切除术与全切术治疗腺瘤型原发性醛固酮增多症的效果.方法 回顾性分析235例腺瘤型原发性醛固酮增多症患者的临床资料.85例行后腹腔镜下肾上腺全切,150例行后腹腔镜下肾上腺部分切除.结果 行肾上腺部分切除组手术时间48.0±15.0 min;术中失血量25.0±10.0 ml;拔引流管时间2.2±1.0 d;术后住院天数7.0±2.5 d;病灶大小15.5±4.5 mm.行肾上腺全切组手术时间37.0±12.0 min;术中失血量23.0±9.0ml;拔引流管时间2.4±1.2 d;术后住院天数6.8±2.0 d;病灶大小16.0±3.0mm.部分切除组和全切组术中失血量、拔引流管时间、住院时间及病灶大小差异无统计学意义(P＞0.05).部分切除组手术时间长于全切组(P＜0.05).随访6个月～2年,所有患者血钾恢复正常,198例血压恢复正常.结论 对于单发醛固酮腺瘤的患者,行肾上腺部分切除术治疗腺瘤型原发性醛固酮增多症安全、有效,而且保留了部分有功能的肾上腺组织,优于肾上腺全切术.     

原发性醛固酮增多症肾上腺皮质腺瘤与皮质增生的超微病理研究

目的 探索研究原发性醛固酮增多症(原醛症)肾上腺皮质腺瘤和皮质增生两种亚型的超微病理结构.方法 对本院原醛症患者的病变标本应用透射电镜等技术进行超微病理研究.结果 原发性醛固酮增多症的两种亚型均有较多的线粒体增生以及线粒体呈长管状伴层状嵴的改变,但是此两种亚型的线粒体内外膜以及线粒体嵴的变化存在较多差异.结论 人体产生醛固酮的肾上腺皮质细胞线粒体的形态及数目存在差异,这种差异与血钾浓度的关系有待进一步研究.     

Outcome of patients undergoing laparoscopic adrenalectomy for primary hyperaldosteronism.

OBJECTIVES: To study the long-term outcome of patients with primary hyperaldosteronism who underwent laparoscopic adrenalectomy and to determine the preoperative predictive factors of persistent hypertension. METHODS: Between 1996 and 2002, 47 patients with primary hyperaldosteronism underwent transperitoneal laparoscopic adrenalectomy at our institution. Their clinical and biochemical parameters were reviewed retrospectively, and the outcome of 46 patients with complete follow-up notes were determined. RESULTS: The study comprised 16 male and 30 female patients with a mean age of 45.6 years (range, 18 to 63 years). Almost all patients had hypertension and hypokalemia at presentation, requiring medication. The average operating time was 127 minutes (range, 70 to 240 min), and the mean postoperative stay was 2.6 days (range, 1 to 5 days). No mortalities occurred, and perioperative morbidity was minimal. Forty-two (91%) patients had adrenal cortical adenoma (including 1 with both adenoma and hyperplasia), and 4 (9%) had adrenal hyperplasia on histology. The average follow-up time was 21 months (range, 1 to 60 months), and at the end of follow-up, all patients had normal serum potassium levels without potassium supplements. Twenty-three (50%) patients were cured of hypertension, and 13 (28%) patients had better control of their hypertension as evidenced by the decrease in the number of antihypertensive medications used. On multivariate analysis, the age of the patient at surgery was shown to be an independent predictive factor of persistent hypertension after successful surgery. CONCLUSION: Laparoscopic adrenalectomy is a safe and effective way to treat primary hyperaldosteronism, especially in controlling hypokalemia and in the management of hypertension. The age of a patient at surgery is an independent preoperative risk factor of persistent hypertension.     

Coexistence of three distinct adrenal tumors in the same adrenal gland in a patient with primary aldosteronism and preclinical Cushing's syndrome

A 62-year-old woman was admitted to our hospital because of hypokalemia. Physical examination revealed no signs of excessive adrenocortical steroid production, as are found in Cushing's syndrome. Her plasma renin activity (PRA) was suppressed (0.10 ng/ml per h), and her serum aldosterone level was high (30.0 ng/dl). PRA was not increased after a renin-releasing test. Her plasma adrenocorticotropic hormone (ACTH) level was low (<5 pg/ml), but her serum cortisol level was normal (21.0 μg/dl). Administration of 8 mg dexamethasone did not suppress her plasma cortisol level. Finally, she was diagnosed with clinical primary aldosteronism associated with preclinical Cushing's syndrome. Magnetic resonance image revealed three sequential nodular masses (each 15 mm × 15 mm) in the right adrenal gland. A right adrenalectomy was performed by endoscopy. The three removed tumors appeared to have different characteristics. Microscopic examination revealed that the upper and lower tumors were adrenocortical adenomas, and the middle tumor was a black adenoma. Immunohistochemical staining for the enzymes involved in cortisol biosynthesis suggested that the upper tumor secreted aldosterone, whereas either or both of the two other tumors secreted cortisol. Surprisingly, at 33 years of age, she had been diagnosed with Cushing's syndrome, due to a cortisol-producing adrenocortical adenoma, and she had received a left adrenalectomy. Clinically and pathophysiologically, this was a very rare case.     

腹膜后腹腔镜手术与开放手术治疗原发性醛固酮增多症临床效果的对照研究

目的:探讨原发性醛固酮增多症(原醛症)行腹膜后腹腔镜手术治疗的效果,并与开放手术进行对照。方法:回顾分析24例行腹膜后腹腔镜手术治疗原醛症患者与22例开放手术患者的临床资料。结果:除平均手术时间外,腹膜后腹腔镜组在失血量、术后止痛剂用量、术后下床活动时间及术后住院天数均显著优于开放组,均未输血和出现严重并发症。术后平均随访6个月,无远期并发症发生。结论:治疗原醛症采用腹膜后腹腔镜手术效果显著,优于开放手术,安全有效,具有患者创伤小、出血少、康复快、住院时间短等优点。     

Endoscopically-assisted laparoscopic partial gastric resection for treatment of a large benign gastric adenoma

Gastric adenomas are benign tumors that are treated by fiberendoscopic removal, but large tumors need a surgical approach for resection. Laparoscopic approach fails to localize the exact placement of the lesion due to lack of sensitivity and fiberoptic control is advisable. We present a case of a large gastric adenoma that was resected by laparoscopy assisted with flexible gastric peroperative endoscopy because the lesion could not be palpated. A lateral gastric resection including the adenoma and wide margins was performed with an endostapler under fiberoptic control. Minimally invasive ancillary techniques enhance the efficacy of laparoscopic surgical procedures, especially in situations in which the lack of tactile feeling limits this approach.