腹腔镜治疗原发性醛固酮增多症(附47例报告)

目的探讨原发性醛酮增多症的腹腔镜微创手术治疗。方法我院经腹腔入路腹腔镜治疗原发性醛固酮增多症患者共47例。肾上腺皮质腺瘤43例,肿瘤平均2.0 cm,32例行肾上腺全切术,11例行肾上腺部分切除术/肿瘤剜除术;肾上腺皮质增生4例,行肾上腺全切术。结果手术时间50~240m in,平均80m in;术中失血量20~300m l,平均76m。l中转开放手术2例(4.2%),其余手术成功。无严重并发症发生。所有患者术后第1天下床活动,术后平均住院时间5d。平均随访16个月,所有患者血钾恢复正常,35例血压恢复正常,其余患者降压药物用量较术前明显减少。结论腹腔入路腹腔镜肾上腺全切术或部分切除/肿瘤剜除术治疗原发性醛固酮增多症,微创、安全、疗效确切。

Transperitoneal laparoscopic procedure for primary aldosteronism: report of 47 cases

Objective To evaluate transperitoneal laparoscopic procedure in the treatment of primary aldosteronism.Methods A total of 47 patients with primary aldosteronism were treated laparoscopically.Of 43 patients with aldosterone-producing adenoma(APA),32 patients underwent unilateral total adrenalectomy while partial adrenalectomy/enucleation in 11 patients.The average size of APA was 2.0cm in diameter.Unilateral total adrenalectomy was performed in 4 patients with adrenal hyperplasia.Results The average operating time was 80 minutes(50~240min).The mean blood loss was 76ml(20~300ml).Two patients(4.2%) were transferred to open surgery.No severe intraoperative or postoperative complications occurred.All patients got ambulated the first postoperative day and the mean hospital stay was 5 days.Mean followup was 16 months.Postoperative blood pressure was normal in 35 patients without taking any drug,while treatment was decreased in the remainder.Kalemia was normalized in all cases.Conclusion Transperitoneal unilateral total adrenalectomy and partial adrenalectomy/enucleation for the primary aldosteronism are minimal invasive,safe and effective.