Meyer Andreas, Behrend Matthias
Abteilung für Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover, Hannover, Deutschland.
Dig Surg. 2004;21(5-6):363-70. doi: 10.1159/000081353. Epub 2004 Oct 5.
The objective of this study was to assess the preoperative symptoms, intra- and postoperative complications and follow-up in patients after uni- or bilateral adrenalectomy due to Cushing's syndrome (CS), independent of etiology.
Clinical charts of 42 patients (5 with ACTH-dependent, 37 with ACTH-independent CS) were reviewed, and follow-up data were obtained from re-examination of the patients.
The symptoms most frequently seen were hypertension, changes of the skin and obesity. Eight bilateral and 36 unilateral adrenalectomies were carried out without any intraoperative complications. Postoperative complications occurred in 5 patients, 1 patient died on the fourth postoperative day. After a mean duration of 4.6 years 28 of 41 patients could be re-examined, 5 patients had died. One patient showed recurrence 4.3 years after unilateral adrenalectomy due to nodular hyperplasia, contralateral adrenalectomy again revealed nodular hyperplasia.
Early diagnosis is essential in order to decrease the rate of pre-, intra- and postoperative complications. Endoscopic approach should be taken in a specialized center due to poor patient's condition. Recurrent disease on the contralateral side may represent bilateral adrenal hyperplasia with sequential tumor formation, demonstrating the importance of extensive preoperative biochemical and imaging testing and close follow-up.
本研究的目的是评估因库欣综合征（CS）接受单侧或双侧肾上腺切除术患者的术前症状、术中和术后并发症及随访情况，病因不限。
回顾了42例患者（5例促肾上腺皮质激素（ACTH）依赖性、37例ACTH非依赖性CS）的临床病历，并通过对患者复查获得随访数据。
最常见的症状为高血压、皮肤改变和肥胖。进行了8例双侧和36例单侧肾上腺切除术，无任何术中并发症。5例患者出现术后并发症，1例患者术后第4天死亡。平均4.6年后，41例患者中的28例接受了复查，5例患者死亡。1例患者因结节性增生在单侧肾上腺切除术后4.3年复发，再次行对侧肾上腺切除术仍显示结节性增生。
为降低术前、术中和术后并发症发生率，早期诊断至关重要。由于患者病情较差，应在专业中心采用内镜手术方法。对侧复发性疾病可能代表双侧肾上腺增生伴相继肿瘤形成，这表明广泛的术前生化和影像学检查以及密切随访的重要性。
