Short-term and long-term follow-up of laparoscopic adrenalectomy for adrenal aldosterone adenoma
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摘要: 目的 探讨腹腔镜肾上腺切除术治疗肾上腺醛固酮腺瘤(aldosterone-producing adenoma，APA)的短期和长期预后。方法 回顾性分析2010年1月—2018年12月在复旦大学附属肿瘤医院泌尿外科就诊的因APA接受腹腔镜肾上腺切除术患者的临床资料。收集患者的基线特征、生化参数、高血压及治疗相关情况、手术相关参数，术后6个月和24个月对所有患者进行随访，以确定生化参数的变化和高血压的临床缓解程度。结果 入组61例患者中，38例接受了腹腔镜肾上腺全切术，23例接受了腹腔镜肾上腺部分切除术。术前55.7%的患者存在高血压，49.2%的患者存在低钾血症。术后患者的低钾血症均得到纠正。在术后6个月的随访中，52.9%的患者高血压完全缓解，44.1%的患者高血压部分缓解；在术后24个月的随访中，55.9%患者高血压完全缓解，41.2%患者符合部分缓解标准。结论 腹腔镜肾上腺切除手术在短期内能够迅速地不同程度地缓解电解质紊乱及高血压异常并且长期持续缓解，是治疗APA安全、有效的方法。Abstract: Objective To explore the short-term and long-term prognosis of laparoscopic adrenalectomy in the treatment of adrenal aldosterone-producing adenoma (APA).Methods A retrospective analysis of 61 patients who underwent laparoscopic adrenalectomy for APA in the Department of Urology in Fudan University Shanghai Cancer Centre between January 2010 and December 2018 was addressed. The baseline characteristics, biochemical parameters, hypertension states, and surgery-related parameters of the patients were collected. All patients were followed up at 6 and 24 months after surgery to determine the changes in biochemical parameters and the degree of clinical remission of hypertension.Results Thirty-eight patients underwent laparoscopic total adrenalectomy, and 23 patients underwent laparoscopic partial adrenalectomy. Before surgery, 55.7% patients were diagnosed of hypertension, and 49.2% of patients had hypokalemia. The postoperative hypokalemia of the patients was corrected. In the 6-month follow-up, 52.9% of patients had complete remission of hypertension, and 44.1% of patients had partial remission of hypertension. During the 24-month follow-up, 55.9% of patients had complete remission of hypertension, and 41.2% of patients met the criteria for partial remission.Conclusion Laparoscopic adrenalectomy is a safe and effective method for the treatment of adrenal aldosterone adenoma, for it can relieve electrolyte imbalance and abnormal hypertension to varying degrees in short-term and long-term follow-up.
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Key words:
- adrenal adenoma /
- aldosterone /
- laparoscopic surgery /
- prognosis
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表 表 1 两组患者的基线特征
X±S 项目 总体(n=61) LTA组(n=38) LPA组(n=23) P值 年龄/岁 55.9±12.0 58.1±12.6 52.3±11.0 0.065 女性/例(%) 35(57.4) 21(55.3) 14(60.9) 0.533 腺瘤大小/cm 3.1±1.5 3.6±1.9 2.4±0.9 0.010 腺瘤位置(左侧)/例(%) 31(50.8) 14(36.8) 17(73.9) 0.008 BMI/(kg·m-2) 24.8±2.5 24.8±2.4 24.9±2.6 0.874 高血压时间/年 2.4±1.6 2.6±1.7 2.2±1.4 0.216 存在高血压并接受药物治疗/例(%) 34(55.7) 21(55.3) 13(56.5) 0.568 术前平均收缩压/mmHg 158.7±13.7 155.8±13.1 163.5±14.6 0.061 术前平均舒张压/mmHg 87.5±9.4 86.7±9.1 88.8±10.0 0.467 术前醛固酮水平/(ng·dL-1) 31.9±15.1 32.2±18.8 31.3±8.9 0.212 术前血浆肾素活性/(ng·mL-1·h-1) 0.15±0.03 0.15±0.03 0.15±0.04 0.332 术前ARR/(ng·dL-1∶ng·mL-1·h-1) 32.2±6.1 32.4±6.8 31.8±5.0 0.495 血钾水平/(mmol·L-1) 2.9±0.5 2.8±0.5 3.0±0.4 0.202 
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表 表 2 两组患者术中及术后临床病理分析比较
例，X±S 项目 LTA组(n=38) LPA组(n=23) P值 手术时间/min 85.1±16.8 96.5±18.6 0.376 手术入路(经腹膜/腹膜后) 26/12 21/2 0.036 出血量/mL 45.3±19.3 65.5±23.8 0.026 总体不良反应 0.600 Clavien-Dindo 1~2级 5 4 Clavien-Dindo 3~4级 1 0 手术相关并发症 0.300 局部血肿 0 2 腹腔积液 1 1 腹壁并发症 1 2 术后并发症 0.99 肺部感染 1 1 静脉栓塞 1 0 心功能不全 0 1 住院时间/d 6.5±2.1 5.8±1.9 0.176 肿瘤大小/cm 3.5±1.9 2.4±0.9 0.013 肿瘤多发 2 1 0.684
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