Campagnacci R, Crosta F, De Sanctis A, Baldarelli M, Giacchetti G, Paganini A M, Coletta M, Guerrieri M
General Surgery and Surgery Methodology Clinic, Polytechnic University of Marche, Hospitals of Ancona, 60121 Ancona, Italy.
J Endocrinol Invest. 2009 Jan;32(1):57-62. doi: 10.1007/BF03345680.
The management of primary aldosteronism is currently achieved by both medical and surgical treatment. Laparoscopy has in recent years unquestionably become the gold standard in adrenal surgery for benign lesions. This study aims to evaluate our clinical results among patients who underwent laparoscopic adrenalectomy (LA) for primary aldosteronism.
From January 1994 to January 2006, amid LA series, 59 primary aldosteronism patients were treated in our institution. Patients were 33 males and 26 females with mean age 49.3 yr (19-78). The mean body mass index was 25.9 kg/m2 (20.5-33.3). The mean size of lesion was 2.9 cm (1-5.5). Clinical symptoms were as follows: hypertension and symptomatic/asymptomatic hypokalemia (54), hypokalemia (5).
Thirty-five left and 24 right LA were performed. On the left side, 22 procedures were carried out by anterior approach, 9 by anterior submesocolic route, and 4 by means of flank approach. All right procedures were completed by the anterior supine approach. The mean operative time was 103.5 min for left and 92.8 min for right adrenalectomy. There was one major complication, a colonic post-operative fistula, regarding a left adrenalectomy case. The mean post-operative hospital stay was 3 days (1-9). The cure rate of hypertension and hypokalemia was similar to the current literature results.
LA is a safe and effective option in the treatment of primary aldosteronism. Appropriate selection of patients, larger adrenal masses and duration of symptoms are determining factors in the success rate of hypertension management.
原发性醛固酮增多症目前通过药物和手术治疗。近年来，腹腔镜检查无疑已成为肾上腺良性病变手术的金标准。本研究旨在评估我们对接受腹腔镜肾上腺切除术（LA）治疗原发性醛固酮增多症患者的临床结果。
1994年1月至2006年1月，在LA系列中，我们机构治疗了59例原发性醛固酮增多症患者。患者中男性33例，女性26例，平均年龄49.3岁（19 - 78岁）。平均体重指数为25.9 kg/m²（20.5 - 33.3）。病变平均大小为2.9 cm（1 - 5.5）。临床症状如下：高血压伴症状性/无症状性低钾血症（54例），低钾血症（5例）。
进行了35例左侧和24例右侧LA。在左侧，22例手术通过前路进行，9例通过结肠下前路进行，4例通过侧腹入路进行。所有右侧手术均通过仰卧位前路完成。左侧肾上腺切除术的平均手术时间为103.5分钟，右侧为92.8分钟。有1例主要并发症，即1例左侧肾上腺切除术后结肠瘘。术后平均住院时间为3天（1 - 9天）。高血压和低钾血症的治愈率与当前文献结果相似。
LA是治疗原发性醛固酮增多症的一种安全有效的选择。患者的适当选择、较大的肾上腺肿块和症状持续时间是高血压治疗成功率的决定因素。
