Auda S P, Brennan M F, Gill J R
Ann Surg. 1980 Jan;191(1):1-7. doi: 10.1097/00000658-198001000-00001.
During the past two decades 50 patients were operated on for primary aldosteronism. Diagnosis was based on high aldosterone excretion or secretion during a high sodium intake and, more recently, low stimulated plasma renin activity. Computed tomography and adrenal venography with selective adrenal vein catheterization for determination of aldosterone/cortisol ratios were helpful in the distinction between adenoma and bilateral hyperplasia. As a result of preoperative localization, unilateral posterior or flank approach to the adrenal has replaced transabdominal as the approach of choice. Overall in-hospital mortality in this series was 10% and occurred exclusively with a transabdominal approach in the early part of the series. Adrenalectomy has been curative in 66% of patients with adenoma and in 38% of patients with hyperplasia which includes patients with adenomatous (dominant macroscopic adenoma, 1 cm or greater) hyperplasia when the cure rate was 75%. Currently, only patients who have unilateral adrenal hyperfunction, who respond to spironolactone with a fall in blood pressure, and who are a good operative risk are considered for operation by posterior or flank approach. These guidelines for the management of primary aldosteronism, used since 1974, have been associated with an excellent response (92%), zero mortality and reduced morbidity.
在过去二十年中，有50例患者接受了原发性醛固酮增多症的手术治疗。诊断依据是高钠摄入期间醛固酮排泄或分泌增加，以及最近的低刺激血浆肾素活性。计算机断层扫描和肾上腺静脉造影以及选择性肾上腺静脉插管以测定醛固酮/皮质醇比值，有助于区分腺瘤和双侧增生。由于术前定位，肾上腺单侧后入路或侧腹入路已取代经腹入路成为首选入路。本系列的总体住院死亡率为10%，且仅在该系列早期的经腹入路手术中出现。肾上腺切除术对66%的腺瘤患者和38%的增生患者有效，其中包括腺瘤样（肉眼可见的优势腺瘤，直径1厘米或更大）增生患者，其治愈率为75%。目前，只有那些单侧肾上腺功能亢进、对螺内酯治疗有血压下降反应且手术风险较低的患者才考虑采用后入路或侧腹入路进行手术。自1974年以来使用的这些原发性醛固酮增多症管理指南，带来了极佳的治疗效果（92%）、零死亡率和更低的发病率。
