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

发布时间：2018-05-16 11:43

本文选题：原发性醛固酮增多症 + 醛固酮腺瘤　；参考：《中国微创外科杂志》2017年03期

【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。
[Abstract]:Objective to compare the efficacy of partial adrenalectomy (PAA) with total adrenalectomy (TAA) in the treatment of unilateral aldosterone-producing adenomatous adenoma (APA). Methods from January 2006 to December 2012, 47 patients with unilateral APA underwent surgical treatment. Among them, 36 cases underwent retroperitoneal partial adrenalectomy and 11 cases underwent retroperitoneal total adrenalectomy. The plasma aldosterone concentration, blood potassium level, blood pressure level and the type of antihypertensive drugs were compared between the two groups. Results the operative time of no intraoperative blood transfusion and conversion to laparotomy in PA group and TA group were 116.5 卤37.0 ~ 100.2 卤42.8 minutes, respectively, and there was no significant difference in the mean intraoperative blood loss of 30 ml(5~400 / L ~ (20) ml(10~300 / min, respectively. The mean time of fasting was 1.7 卤0.71.7 卤0.6 ~ (th) d, with no significant difference in the mean intraoperative bleeding volume of 30 ml(5~400 / L ~ (-1. 267) P ~ (+) P ~ (0. 205) and no significant difference in fasting time (n = 1. 7 卤0. 77 卤0. 6 卤0. 6d), respectively. There was no significant difference in the length of postoperative hospital stay (8.2 卤2.2) and the postoperative hospitalization time was 8.2 卤2.2 卤2.0 days, and there was no significant difference (mean 30 months) between 47 cases followed up for 6 ~ 97 months (mean 30 months), while the postoperative hospitalization time was 8. 2 卤2. 2 卤2. 01 卤2. 0 days, there was no significant difference in the mean follow-up time between 6 to 97 months (mean 30 months), and there was no recurrence after the operation, and the postoperative hospitalization time was 8. 1 卤2. 0 卤2. 0 days, and there was no significant difference between the two groups in the mean follow-up period of 6 ~ 97 months (mean 30 months). The cure rate and improvement rate of hypertension were 61.1% and 36.4%, respectively, and the ineffective rates were 61.1% and 63.6% respectively. There was no significant difference between the two groups. There was no significant difference between the two groups. Conclusion in the surgical treatment of unilateral adrenal APA, PA under retroperitoneal laparoscopy is safe and feasible, and the curative effect is the same as that of TAA.
【作者单位】：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;
【基金】：国家自然科学基金(项目编号:81172421)
【分类号】：R699.3

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