Department of Surgery, University Hospital Giessen and Marburg, Baldingerstraße 1, 35043, Marburg, Germany.
World J Surg. 2011 Nov;35(11):2422-7. doi: 10.1007/s00268-011-1221-5.
Primary hyperaldosteronism (PHA) frequently causes secondary hypertension and is a surgically amenable disease if associated with unilateral adenoma. Patients who underwent laparoscopic adrenalectomy at the authors' department were followed to identify clinical parameters that predict resolution of hypertension.
All patients with PHA and adrenalectomy from 1993 to 2009 were identified. Charts and follow-up data were reviewed for clinical parameters and hormone levels. Univariate and multivariate analysis were performed with SPSS 15.0.
A cohort of 30 female and 24 male patients underwent laparoscopic adrenalectomy. Hypokalemia was observed in 47/54 (87%) patients. Twenty patients (37%) were cured without any further need of antihypertensive medication, 20 (37%) patients experienced an improvement in hypertension, and 14 (26%) patients remain unaffected. Consequently, hypertension was resolved or improved in 40/54 (74%) patients. A shorter duration of hypertension (<6 years), the number of antihypertensive drugs (<3), and the serum creatinine level (<1.3 mmol/l) were independent predictors of resolution of hypertension in a multivariate analysis. At final follow-up after a mean of 49 ± 40 months, resolution of hypertension was observed in 17/30 (57%) patients. Interestingly, in 10/17 patients a period longer than 12 months was required before a resolution of hypertension was observed. Coexistent hyperplasia, which was observed in 30% of patients, did not correlate with outcome.
In 50% of patients with PHA, hypertension resolves after laparoscopic adrenalectomy, but the process may require more than 12 months. Patients with a duration of hypertension of more than 6 years, more than 3 antihypertensive drugs, and elevated serum creatinine have a higher risk of persistent hypertension after surgery. Coexistent hyperplasia in the resected adrenal gland is not associated with persistent hypertension.
原发性醛固酮增多症（PHA）常导致继发性高血压，如果与单侧腺瘤有关，则是一种可通过手术治疗的疾病。作者所在科室对接受腹腔镜肾上腺切除术的患者进行了随访，以确定预测高血压缓解的临床参数。
从 1993 年至 2009 年，确定了所有患有 PHA 和肾上腺切除术的患者。对图表和随访数据进行了回顾，以评估临床参数和激素水平。使用 SPSS 15.0 进行单变量和多变量分析。
一组 30 名女性和 24 名男性患者接受了腹腔镜肾上腺切除术。47/54（87%）名患者出现低钾血症。20 名（37%）患者无需进一步使用抗高血压药物即可治愈，20 名（37%）患者高血压得到改善，14 名（26%）患者未受影响。因此，在 54 名患者中，40 名（74%）患者的高血压得到缓解或改善。多变量分析显示，高血压病程较短（<6 年）、降压药数量较少（<3 种）和血清肌酐水平较低（<1.3mmol/l）是高血压缓解的独立预测因素。在平均 49±40 个月的最终随访时，17/30（57%）名患者的高血压得到缓解。有趣的是，在 10/17 名患者中，需要超过 12 个月的时间才能观察到高血压的缓解。在 30%的患者中观察到共存增生，但与结果无关。
在 50%的 PHA 患者中，高血压在腹腔镜肾上腺切除术后得到缓解，但这一过程可能需要超过 12 个月。高血压病程超过 6 年、使用超过 3 种降压药和血清肌酐升高的患者术后持续性高血压的风险更高。切除的肾上腺中存在共存增生与持续性高血压无关。
