Jiang Shao-bo, Guo Xu-dong, Wang Han-bo, Gong Ruo-zhen, Xiong Hui, Wang Zheng, Zhang Hai-yang, Jin Xun-bo
Minimally Invasive Urology Center, East District of Provincial Hospital Affiliated to Shandong University, 9th Floor, Block C, No. 9677, East Jingshi Road, Jinan, 250014, People's Republic of China.
Int Urol Nephrol. 2014 Jul;46(7):1283-8. doi: 10.1007/s11255-013-0614-9. Epub 2014 Feb 2.
To evaluated the long-term outcomes of laparoscopic unilateral adrenalectomy for primary aldosteronism (PA) caused by unilateral adrenal hyperplasia (UAH).
One hundred and sixty-four patients who underwent laparoscopic unilateral adrenalectomy for UAH from January 2004 to December 2011 were entered in this retrospective analysis. Patients demographics, perioperative parameters, and follow-up results were recorded and analyzed statistically.
All 164 cases suffered hypertension with biochemical evidence of hyperaldosteronism prior to operation. Hypokalemia was observed in 52/164 (37.14%) patients. UAH was proved by multi-slice computed tomography (MSCT). All operations were completed successfully without any conversions or complications. Postoperative pathology confirmed that 164 cases were cortical nodular hyperplasia, of which 4 cases coexist with medullary hyperplasia and 7 with micro-adenoma. At the median follow-up of 48 months, hypertension was cured in 88 (53.7%) patients, improved in 71 (43.3%) patients, and refractory in 5 (3.05%) patients. Hypokalemia and hyperaldosteronism were cured in all patients except re-elevation of blood pressure and plasma aldosterone in two patients 1 month after adrenalectomy.
As an underestimated subtype of PA, UAH is accepted gradually. Laparoscopic unilateral adrenalectomy is nowadays the preferred approach to treat patients with PA caused by UAH. When adrenal venous sampling is not allowed, high-resolution MSCT is a reliable test for lateralization of aldosterone hypersecretion in carefully selected patients and 97% had either cure or improvement in blood pressure control.
评估腹腔镜单侧肾上腺切除术治疗单侧肾上腺增生（UAH）所致原发性醛固酮增多症（PA）的长期疗效。
对2004年1月至2011年12月期间因UAH接受腹腔镜单侧肾上腺切除术的164例患者进行回顾性分析。记录患者的人口统计学资料、围手术期参数及随访结果，并进行统计学分析。
所有164例患者术前均患有高血压且有醛固酮增多症的生化证据。52/164（37.14%）例患者存在低钾血症。多层螺旋计算机断层扫描（MSCT）证实为UAH。所有手术均成功完成，无中转或并发症。术后病理证实164例为皮质结节性增生，其中4例合并髓质增生，7例合并微腺瘤。中位随访48个月时，88例（53.7%）患者高血压治愈，71例（43.3%）患者改善，5例（3.05%）患者难治。除2例患者肾上腺切除术后1个月血压和血浆醛固酮再次升高外，所有患者的低钾血症和醛固酮增多症均治愈。
作为PA的一种被低估的亚型，UAH逐渐被认可。腹腔镜单侧肾上腺切除术是目前治疗UAH所致PA患者的首选方法。当不允许进行肾上腺静脉采血时，高分辨率MSCT是精心挑选患者中醛固酮分泌增多症侧别定位的可靠检查方法，97%的患者血压控制得到治愈或改善。
