不同手术方式治疗醛固酮腺瘤患者的有效性及安全性探讨
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摘要
目的通过对比腹膜后腹腔镜下肾上腺全切术与腹膜后腹腔镜下肾上腺肿瘤切除术治疗醛固酮腺瘤患者的相关指标,为临床应用后腹腔镜下肾上腺肿瘤切除术治疗醛固酮腺瘤患者提供依据。方法回顾性分析2014年1月～2018年9月重庆医科大学附属第一医院收治的103例醛固酮腺瘤患者的临床资料,32例行后腹腔镜下肾上腺全切术,71例行后腹腔镜下肾上腺肿瘤切除术。术后随访1～41个月,平均15.7个月。比较两组患者手术时间、术中术后并发症发生率,术后皮质醇不足发生率、引流管留置时间、术后住院时间,术后血压缓解率及复发率。结果肾上腺全切组手术时间为(117.00±47.00)min,术中术后并发症发生率为9.37%,术后住院时间为(5.20±3.10)d,均高于肾上腺肿瘤切除组的(78.00±32.00)min、0、(4.00±1.10)d,差异有统计学意义(P<0.05);两组患者术中出血量及引流管留置时间,术后皮质醇不足发生率比较,差异无统计学意义(P>0.05)。全切组和肿瘤切除组术后血压缓解率分别为90.63%和81.69%,组间比较差异无统计学意义(P>0.05),全切组复发率为0,低于肿瘤切除组的4.23%,但二者间差异无统计学意义(P>0.05)。结论鉴于后腹腔镜下肾上腺肿瘤切除术的良好的手术效果,技术上安全可靠,虽然有较小概率复发可能,仍是醛固酮腺瘤患者的一个良好选择。
Objective To compare the relevant parameters of retroperitoneal laparoscopic adrenalectomy and retroperitoneal laparoscopic adrenalectomy for patients with aldosterone adenoma, and to provide a basis for clinical application of laparoscopic adrenalectomy for aldosterone adenoma. Methods Retrospective analysis of clinical data of 103 patients with aldosterone adenoma admitted to the First Affiliated Hospital of Chongqing Medical University from January 2014 to September 2018,32 patients underwent retroperitoneal laparoscopic adrenalectomy, and 71 patients underwent retroperitoneal laparoscopic adrenal gland Tumor resection. The patients were followed up for 1 to 41 months, with an average of 15.7 months. The operation time, intraoperative and postoperative complications, postoperative cortisol deficiency, drainage tube indwelling time, postoperative hospital stay, postoperative blood pressure remission rate and recurrence rate were compared between the two groups. Results The operation time of the adrenal gland was(117.00±47.00) min, the postoperative complication rate was 9.37%, and the postoperative hospital stay was(5.20 ±3.10) d, which was higher than that of the adrenal tumor resection group(78.00 ±32.00) min,0,(4.00±1.10) d, the difference was statistically significant(P<0.05); the intraoperative blood loss and drainage tube indwelling time, the incidence of postoperative cortisol deficiency, the difference was not statistically significant(P>0.05). The postoperative blood pressure remission rate was 90.63% and 81.69% in the total cut group and the tumor resection group,respectively. There was no significant difference between the two groups(P>0.05).The recurrence rate in total resection group was 0 lower than that in tumor resection group 4.23%, but there was no significant difference between the two groups(P >0.05). Conclusion In view of the good surgical results of retroperitoneal laparoscopic adrenalectomy, it is technically safe and reliable, and although it has a small probability of recurrence, it is still a good choice for patients with aldosterone adenoma.
Objective To compare the relevant parameters of retroperitoneal laparoscopic adrenalectomy and retroperitoneal laparoscopic adrenalectomy for patients with aldosterone adenoma, and to provide a basis for clinical application of laparoscopic adrenalectomy for aldosterone adenoma. Methods Retrospective analysis of clinical data of 103 patients with aldosterone adenoma admitted to the First Affiliated Hospital of Chongqing Medical University from January 2014 to September 2018,32 patients underwent retroperitoneal laparoscopic adrenalectomy, and 71 patients underwent retroperitoneal laparoscopic adrenal gland Tumor resection. The patients were followed up for 1 to 41 months, with an average of 15.7 months. The operation time, intraoperative and postoperative complications, postoperative cortisol deficiency, drainage tube indwelling time, postoperative hospital stay, postoperative blood pressure remission rate and recurrence rate were compared between the two groups. Results The operation time of the adrenal gland was(117.00±47.00) min, the postoperative complication rate was 9.37%, and the postoperative hospital stay was(5.20 ±3.10) d, which was higher than that of the adrenal tumor resection group(78.00 ±32.00) min,0,(4.00±1.10) d, the difference was statistically significant(P<0.05); the intraoperative blood loss and drainage tube indwelling time, the incidence of postoperative cortisol deficiency, the difference was not statistically significant(P>0.05). The postoperative blood pressure remission rate was 90.63% and 81.69% in the total cut group and the tumor resection group,respectively. There was no significant difference between the two groups(P>0.05).The recurrence rate in total resection group was 0 lower than that in tumor resection group 4.23%, but there was no significant difference between the two groups(P >0.05). Conclusion In view of the good surgical results of retroperitoneal laparoscopic adrenalectomy, it is technically safe and reliable, and although it has a small probability of recurrence, it is still a good choice for patients with aldosterone adenoma.
引文
[1]那彦群,叶章群,孙颖浩.中国泌尿外科疾病诊断治疗指南(2014版)[M].北京:人民卫生出版社,2013:555-594.
[2]Funder JW,Carey RM,Mantero F,et al.The Management of Primary Aldosteronism:Case Detection, Diagnosis,and Treatment:An Endocrine Society Clinical Practice Guideline[J].J Clin Endocrinol Metab,2016,101(5):1889-1916.
[3]Sang X,Jiang Y,Wang W,et al.Prevalence of and risk factors for primary aldosteronism among patients with resistant hypertension in China[J].J Hypertens,2013,31(7):1465-1471.
[4]陈景宇,黄锐,谢进东.腹膜后腹腔镜肾上腺部分切除术与全切除术治疗醛固酮瘤的对比研究[J].中华腔镜泌尿外科杂志,2013,7(4):272-275.
[5]中华医学会内分泌学分会肾上腺学组.原发性醛固酮增多症诊断治疗指南的专家共识[J].中华内分泌代谢杂志,2016,32(3):188-195.
[6]Dick SM,Queiroz M,Bernardi BL,et al.Update in diagnosis and management of primary aldosteronism[J].Clin Chem Lab Med,2018,56(3):360-372.
[7]张尧,吴小候.重视原发性醛固酮增多症的筛查与诊断[J].重庆医学,2018,47(12):4325-4330.
[8]Colleselli D,Janetschek G.Current trends in partial adrenalectomy[J].Curr Opin Urol,2015,25(2):89-94.
[9]Ishidoya S,Ito A,Sakai K,et al.Laparoscopic partial versus total adrenalectomy for aldosterone producing adenoma[J].J Urol,2005,174(1):40-43.
[10]肖维仁,王敏捷,薛永平,等.保留肾上腺手术与肾上腺全切除术治疗醛固酮腺瘤疗效比较的meta分析[J].解放军医学杂志,2017,42(5):432-438.
[11]李新涛,马鑫,吕香均,等.后腹腔镜肾上腺切除与部分肾上腺切除治疗醛固酮瘤的疗效比较[J].微创泌尿外科,2013,2(5):317-320.
[12]王亮,李黎明,林毅.腹腔镜行肾上腺部分切除术与全切术治疗肾上腺原醛瘤的比较:附235例报告[J].中华腔镜泌尿外科杂志(电子版),2012,6(2):92-94.
[13]薛永平,肖维仁,王敏捷,等.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[J].中国微创外科杂志,2017,17(3):209-212.
[14]Chai YJ,Yu HW,Song RY,et al.Lateral Transperitoneal Adrenalectomy Versus Posterior Retroperitoneoscopic Adrenalectomy for Benign Adrenal Gland Disease:Randomized Controlled Trial at a Single Tertiary Medical Center[J].Ann Surg,2017.
[2]Funder JW,Carey RM,Mantero F,et al.The Management of Primary Aldosteronism:Case Detection, Diagnosis,and Treatment:An Endocrine Society Clinical Practice Guideline[J].J Clin Endocrinol Metab,2016,101(5):1889-1916.
[3]Sang X,Jiang Y,Wang W,et al.Prevalence of and risk factors for primary aldosteronism among patients with resistant hypertension in China[J].J Hypertens,2013,31(7):1465-1471.
[4]陈景宇,黄锐,谢进东.腹膜后腹腔镜肾上腺部分切除术与全切除术治疗醛固酮瘤的对比研究[J].中华腔镜泌尿外科杂志,2013,7(4):272-275.
[5]中华医学会内分泌学分会肾上腺学组.原发性醛固酮增多症诊断治疗指南的专家共识[J].中华内分泌代谢杂志,2016,32(3):188-195.
[6]Dick SM,Queiroz M,Bernardi BL,et al.Update in diagnosis and management of primary aldosteronism[J].Clin Chem Lab Med,2018,56(3):360-372.
[7]张尧,吴小候.重视原发性醛固酮增多症的筛查与诊断[J].重庆医学,2018,47(12):4325-4330.
[8]Colleselli D,Janetschek G.Current trends in partial adrenalectomy[J].Curr Opin Urol,2015,25(2):89-94.
[9]Ishidoya S,Ito A,Sakai K,et al.Laparoscopic partial versus total adrenalectomy for aldosterone producing adenoma[J].J Urol,2005,174(1):40-43.
[10]肖维仁,王敏捷,薛永平,等.保留肾上腺手术与肾上腺全切除术治疗醛固酮腺瘤疗效比较的meta分析[J].解放军医学杂志,2017,42(5):432-438.
[11]李新涛,马鑫,吕香均,等.后腹腔镜肾上腺切除与部分肾上腺切除治疗醛固酮瘤的疗效比较[J].微创泌尿外科,2013,2(5):317-320.
[12]王亮,李黎明,林毅.腹腔镜行肾上腺部分切除术与全切术治疗肾上腺原醛瘤的比较:附235例报告[J].中华腔镜泌尿外科杂志(电子版),2012,6(2):92-94.
[13]薛永平,肖维仁,王敏捷,等.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[J].中国微创外科杂志,2017,17(3):209-212.
[14]Chai YJ,Yu HW,Song RY,et al.Lateral Transperitoneal Adrenalectomy Versus Posterior Retroperitoneoscopic Adrenalectomy for Benign Adrenal Gland Disease:Randomized Controlled Trial at a Single Tertiary Medical Center[J].Ann Surg,2017.