肾上腺结节样增生性高血压的影像学检查(附117例分析)

目的:比较各种影像学检查对肾上腺结节样增生性高血压的检出情况,探讨多层螺旋CT薄层扫描在肾上腺结节样增生性高血压诊断中的优越性及临床意义。方法:回顾性分析2003年6月～2008年6月间手术病理诊断的肾上腺结节样增生患者117例,其中肾上腺皮质结节样增生112例,肾上腺皮质结节样增生伴髓质增生5例,分别行肾上腺超声、磁共振及多层螺旋CT薄层扫描。比较手术前后患者血压及生化指标变化。结果:行螺旋CT薄层扫描者112例,发现异常108例,检查阳性率96.4%,明确诊断105例,符合诊断率93.8%。螺旋CT薄层扫描对肾上腺结节样增生性高血压的符合诊断率显著优于B超(P0.01)及磁共振检查(P0.01)。117例均行腹腔镜患侧肾上腺全切术,106例术后血压恢复正常,手术有效率90.6%。结论:顽固性高血压患者怀疑为肾上腺结节样增生时,宜首先考虑行螺旋CT薄层扫描。肾上腺结节样增生性高血压患者应行腹腔镜患侧肾上腺全切术。

Detection of adrenal nodular hyperplastic hypertension by different imageological methods

Objective：To determine the diagnostic value of multi-slice spiral CT（MSCT） in patients with adrenal nodular hyperplastic hypertension by comparing other imageology methods used.Methods：One hundred and seventeen cases of adrenal nodular hyperplastic hypertension,in which 112 cases were diagnosed pathologically with adrenocortical nodular hyperplasia and 5 cases with nodular adrenocortical hyperplasia and medullary hyperplasia between June 2003 and June 2008 in our department,were enrolled in this retrospective study.The patients underwent adrenal ultrasound,MRI and MSCT.We applied one-factor analysis of variance to analyse the degree of blood pressures before operation and after operation.Results：Among the 117 cases,MSCT was performed in 112 cases and 108 were found to be abnormal,and the PR was 96.4%,105 cases were diagnosed by MSCT and the DR was 93.8%.As compared with adrenal ultrasound and MRI,MSCT had statistically significant superiority（P0.01）.Laparoscopic ipsilateral adrenalectomy was performed in all the 117 cases.The blood pressure of 106 cases decreased to normal after operation,and the effective rate was 90.6%.Conclusion：To shorten the diagnosis time,patients with resistant hypertension should be recommended to undergo MSCT first.The patients with adrenal nodular hyperplastic hypertension should be performed laparoscopic resection of ipsilateral adrenal gland.