Department of Urology, Affiliated Kunshan Hospital of Jiangsu University, No.91 Qianjin West Road, Suzhou 215300, China
Department of Urology, the First Affiliate Hospital of Soochow University, No.188 Shizi Street, Suzhou 215006, China.
Urol J. 2020 Jun 23;17(4):4981. doi: 10.22037/uj.v0i0.4981.
Laparoscopy surgery is the gold standard for the treatment of aldosterone-producing adenomas (APA). However, the effectiveness between laparoscopic total and partial adrenalectomy is controversial. Therefore, we retrospectively analyzed the postoperative and follow-up outcomes of these two procedures.
A total of 96 APA patients underwent laparoscopic surgery in our hospital between January 2012 and December 2017. A total of 65 patients who underwent laparoscopic partial adrenalectomy (group 1) were compared with 31 patients who underwent laparoscopic total adrenalectomy (group 2). The mean follow-up time was 32.3 months and 40.8 months, respectively. Patient's preoperative characteristics, date during surgery, and postoperative clinical results of the two groups were analyzed.
In both groups of patients, laparoscopic adrenalectomy was successfully carried out. The laparoscopic partial adrenalectomy group had a shorter operation time when compared to total adrenalectomy (P = .01). However, patients in the laparoscopic total adrenalectomy group were older (P = .04) and had a higher proportion of multiple adenomas (P = .01) compared to partial adrenalectomy. Five patients (7.7%) who underwent partial adrenalectomy did not show improvement in hypertension and/or serum potassium below normal levels, and review of plasma aldosterone concentration (PAC) and/or computerized tomography (CT) indicated that surgery was not successful in these patients. All 31 patients who underwent total adrenalectomy showed improvement or recovery from hypertension, and all PAC and serum potassium levels returned to normal levels after surgery.
Although both surgical procedures were technically safe and feasible, laparoscopic partial adrenalectomy showed a higher failure rate (7.7%) for patients with APA. Therefore, choosing laparoscopic partial adrenalectomy requires careful consideration, and we selected laparoscopic total adrenalectomy in patients with unilateral APA.
腹腔镜手术是治疗醛固酮分泌腺瘤（APA）的金标准。然而，腹腔镜全肾上腺切除术和部分肾上腺切除术的疗效仍存在争议。因此，我们回顾性分析了这两种手术的术后和随访结果。
我院于 2012 年 1 月至 2017 年 12 月期间共对 96 例 APA 患者进行了腹腔镜手术。共 65 例行腹腔镜部分肾上腺切除术（1 组），31 例行腹腔镜全肾上腺切除术（2 组）。两组的平均随访时间分别为 32.3 个月和 40.8 个月。分析了两组患者的术前特征、手术时间及术后临床结果。
两组患者均成功完成腹腔镜肾上腺切除术。腹腔镜部分肾上腺切除术组的手术时间明显短于全肾上腺切除术组（P =.01）。然而，全肾上腺切除术组患者年龄较大（P =.04），且多发性腺瘤的比例较高（P =.01）。5 例（7.7%）行部分肾上腺切除术的患者高血压和/或血清钾未恢复正常，复查血浆醛固酮浓度（PAC）和/或计算机断层扫描（CT）提示手术不成功。31 例行全肾上腺切除术的患者术后高血压均有改善或恢复，所有 PAC 和血清钾水平均恢复正常。
虽然两种手术方法在技术上均安全可行，但腹腔镜部分肾上腺切除术治疗 APA 的失败率（7.7%）较高。因此，选择腹腔镜部分肾上腺切除术需要慎重考虑，我们选择单侧 APA 患者行腹腔镜全肾上腺切除术。
