Duncan J L, Fuhrman G M, Bolton J S, Bowen J D, Richardson W S
Department of Surgery, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana 70121, USA.
Am Surg. 2000 Oct;66(10):932-5; discussion 935-6.
We reviewed our institutional experience with primary hyperaldosteronism to compare clinical outcomes after laparoscopic versus open adrenalectomy. All patients surgically treated for primary hyperaldosteronism from 1988 through 1999 are included in this study. Patients were assigned to either the LA (laparoscopic) or OA (open) group depending on the initial surgical approach selected for treatment. Records were reviewed to determine demographics, operative results, and complications. Twenty-four patients were surgically treated for primary hyperaldosteronism. There were no significant differences between groups with respect to age, weight, number of preoperative antihypertensive medications, or preoperative potassium level. The results of adrenalectomy with respect to number of postoperative antihypertensive medications or serum potassium level were also similar. Operative times were not significantly different (191 +/- 53 minutes for OA and 205 +/- 88 minutes for LA) between groups, but four LA patients were converted to OA. Estimated blood loss was 401 +/- 513 cm3 for OA and 127 +/- 131 cm3 for LA (P = 0.07). Hospital length of stay was 6.7 +/- 3.7 days for OA and 3.3 +/- 2.7 days for LA (P = 0.02). Complications were nine for OA and three for LA (P = 0.001 by Pearson's Chi square). LA is similar to OA in the treatment of primary hyperaldosteronism. The significantly fewer complications and shorter length of hospital stay associated with LA makes the laparoscopic approach the preferred method for treating primary hyperaldosteronism.
我们回顾了本机构原发性醛固酮增多症的治疗经验，以比较腹腔镜肾上腺切除术与开放性肾上腺切除术后的临床结果。本研究纳入了1988年至1999年期间接受原发性醛固酮增多症手术治疗的所有患者。根据最初选择的手术治疗方法，将患者分为腹腔镜（LA）组或开放性（OA）组。查阅记录以确定人口统计学、手术结果和并发症情况。24例患者接受了原发性醛固酮增多症的手术治疗。两组在年龄、体重、术前抗高血压药物数量或术前血钾水平方面无显著差异。肾上腺切除术后抗高血压药物数量或血清钾水平的结果也相似。两组间手术时间无显著差异（OA组为191±53分钟，LA组为205±88分钟），但有4例LA组患者转为OA组手术。OA组估计失血量为401±513 cm³，LA组为127±131 cm³（P = 0.07）。OA组住院时间为6.7±3.7天，LA组为3.3±2.7天（P = 0.02）。OA组并发症有9例，LA组有3例（Pearson卡方检验P = 0.001）。在原发性醛固酮增多症的治疗中，LA与OA相似。LA相关并发症明显较少且住院时间较短，这使得腹腔镜手术成为治疗原发性醛固酮增多症的首选方法。
