肾上腺切除治疗肾上腺增生性高血压的临床疗效观察与分析

发布时间：2019-03-16 19:17

【摘要】：目的探讨肾上腺增生性高血压患者的临床及病理特点，评估肾上腺增生性高血压患者术后临床疗效及分析影响疗效的可能因素。方法回顾性分析2012年1月至2012年12月我科收治的肾上腺增生性高血压的基本资料包括性别、年龄、病程、术前临床表现、内分泌检查结果、影像学和术后病理结果特点，并电话随访其术后临床症状、血压改善情况及降压药服用情况，综合评估手术效果，结合统计学方法，分析影响疗效的因素，探讨诊断及治疗方面存在的的问题。结果本组病例75例，，男39例，女36例。年龄20-74岁，平均47岁。术后病理报告弥漫性增生占56%（42/75例），结节性增生占26%（26/75例），皮质、髓质混合性增生占%（6/75例）。术后随访时间11~21个月，平均随访时间15.6个月，分为治愈、改善及无效组。治愈组：停用降压药，血压正常或症状消失；改善组：降压药未减量或已减量或停药，而血压较术前下降，或症状好转。无效：降压药未减量，血压较术前为未下降，或症状无缓解。结果完全有效占31.2%（23/75例），有效果占56.2%（42/75例），无效果占13.3%（10/75例）。对患者术前及术后血压进行统计学对照，结果发现存在显著差异，有统计学意义。经统计分析，患者年龄、病程及术前血压对术后疗效的影响存在显著差异，且差异具有统计学意义，是影响术后疗效的因素；而性别、病变侧别、术后随访时间、病理类型及术前影像学改变间差异无明显意义。结论一侧肾上腺切除对大多数患者可控制血压及症状，手术治疗是一种安全、有效的可能使部分患者受益的治疗方法，且术前及术后需控制好血压，术后应继续监测血压。患者年龄、高血压级别、术前病程可能对患者术后治疗效果存在一定的影响；而患者性别、病变侧别、术后随访时间及病理类型及术前影像学变化对术后疗效影响不大。此外，肾上腺增生性高血压患者临床表现不特异，临床表现多样化，大多数病人均伴有不同程度的高血压或头晕、头痛，因此对于症状性高血压患者，特别是药物治疗效果欠佳时，应考虑到肾上腺是否存在病变，可给与行相关肾上腺内分泌检查和影像学检查。患者临床表现、影像学检查及内分泌检查存在不相符合的情况，因此我们应综合上述三方面来做出初步诊断，最终要依靠病理诊断。
[Abstract]:Objective to investigate the clinical and pathological features of patients with adrenal hyperplastic hypertension (ADH), evaluate the clinical efficacy and analyze the possible factors influencing the curative effect. Methods from January 2012 to December 2012, the basic data of adrenal hyperplastic hypertension, including sex, age, course of disease, preoperative clinical manifestation, endocrine examination, imaging and postoperative pathological features, were retrospectively analyzed. The clinical symptoms, the improvement of blood pressure and the use of antihypertensive drugs were followed up by telephone. Combined with statistical methods, the factors affecting the curative effect were analyzed, and the problems existed in the diagnosis and treatment were discussed. Results there were 75 cases, 39 males and 36 females. The age was 20 to 74, with an average of 47. Diffuse hyperplasia (56%), nodular hyperplasia (26%, 75 cases) and mixed hyperplasia of cortex and medulla (6 cases) were found in 56% (42 / 75), 26% (26 / 75) and 6 / 75 (6 / 75) respectively. The follow-up time was 11 to 21 months, the mean follow-up time was 15.6 months, and divided into cure, improvement and ineffective group. In the treatment group, the blood pressure was normal or the symptoms disappeared. In the improvement group, the antihypertensive drugs were not reduced or had been reduced or stopped, but the blood pressure was lower than that before the operation, or the symptoms were improved. Ineffective: the antihypertensive drug did not decrease, blood pressure did not decrease, or symptoms did not relieve. Results the total effective rate was 31.2% (23 / 75), the effective rate was 56.2% (42 / 75) and the ineffective rate was 13.3% (10 / 75). The blood pressure of the patients before and after operation were compared statistically, the results showed that there was significant difference between the two groups (P < 0.05). Statistical analysis showed that the patients' age, course of disease and preoperative blood pressure had significant difference in the postoperative curative effect, and the difference was statistically significant, which was the factor influencing the postoperative curative effect. There was no significant difference in sex, side of lesion, follow-up time, pathological type and preoperative imaging changes. Conclusion unilateral adrenalectomy can control blood pressure and symptoms in most patients. Surgical treatment is a safe and effective treatment that may benefit some patients, and blood pressure should be controlled well before and after operation. Blood pressure should continue to be monitored after operation. The age, the grade of hypertension and the course of disease before operation may have some influence on the curative effect of the patients, but the gender, the side of the lesion, the follow-up time, the pathological type and the preoperative imaging changes have little effect on the postoperative curative effect. In addition, the clinical manifestations of adrenal hyperplastic hypertension patients are not specific, clinical manifestations are diverse, most patients are accompanied by varying degrees of hypertension or dizziness, headache, so for symptomatic hypertension patients, Especially when the effect of drug therapy is poor, we should take into account whether there is any pathological changes in adrenal gland, and can give related adrenal endocrine examination and imaging examination. The clinical manifestation, imaging examination and endocrine examination of the patients do not accord with each other. Therefore, we should combine the above three aspects to make a preliminary diagnosis, and ultimately rely on pathological diagnosis.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.3

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