Namekawa Takeshi, Utsumi Takanobu, Tanaka Tomoaki, Kaga Mayuko, Nagano Hidekazu, Kono Takashi, Kawamura Koji, Kamiya Naoto, Imamoto Takashi, Suzuki Hiroyoshi, Ichikawa Tomohiko
Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Urology, Toho University Sakura Medical Center, Shimoshizu 564-1, Sakura-Shi, Chiba, 285-8741, Japan.
World J Surg. 2017 Apr;41(4):986-990. doi: 10.1007/s00268-016-3822-5.
Laparoscopic adrenalectomy has been established as a standard surgical method for unilateral primary aldosteronism. Meanwhile, the background characteristics of the patients undergoing adrenalectomy have changed over the last 20 years. The aim of this study was to investigate the changes in hypertension cure rates after laparoscopic adrenalectomy during the last two decades.
This retrospective clinical study included 176 patients who underwent unilateral laparoscopic adrenalectomy for primary aldosteronism from 1995 to 2015. The patients were divided into two groups by decade. The patients' baseline characteristics and the hypertension cure rates were compared between the two groups. Additionally, the values were re-examined based on predictive model predicting postoperative hypertension cure.
The hypertension cure rate decreased significantly from 51.8 to 31.1%. The following variables were significantly different between the two groups: age, sex, body mass index, history of diabetes mellitus, preoperative systolic and diastolic blood pressures, potassium level, and plasma renin activity.
This study showed that the number of patients with unfavorable conditions for hypertension cure after adrenalectomy has recently increased. The treatment goal for primary aldosteronism is not only to cure the hypertension but also to prevent organ disorders due to inappropriate aldosterone levels. Therefore, we recommend laparoscopic adrenalectomy for unilateral primary aldosteronism, even if hypertension is not always cured postoperatively. However, clinicians need to fully explain the postoperative hypertension outcomes to primary aldosteronism patients.
腹腔镜肾上腺切除术已成为治疗单侧原发性醛固酮增多症的标准手术方法。与此同时，过去20年中接受肾上腺切除术患者的背景特征发生了变化。本研究旨在调查过去二十年中腹腔镜肾上腺切除术后高血压治愈率的变化。
这项回顾性临床研究纳入了1995年至2015年期间因原发性醛固酮增多症接受单侧腹腔镜肾上腺切除术的176例患者。患者按十年分为两组。比较两组患者的基线特征和高血压治愈率。此外，根据预测术后高血压治愈率的预测模型对这些值进行重新检查。
高血压治愈率从51.8%显著下降至31.1%。两组之间在以下变量上存在显著差异：年龄、性别、体重指数、糖尿病史、术前收缩压和舒张压、血钾水平以及血浆肾素活性。
本研究表明，近期肾上腺切除术后不利于高血压治愈的患者数量有所增加。原发性醛固酮增多症的治疗目标不仅是治愈高血压，还包括预防因醛固酮水平异常导致的器官损害。因此，对于单侧原发性醛固酮增多症，我们建议行腹腔镜肾上腺切除术，即使术后高血压不一定能治愈。然而，临床医生需要向原发性醛固酮增多症患者充分解释术后高血压的转归情况。
