Saiko Y, Minowada S, Shinohara M, Nutahara K, Homma Y, Higashihara E, Aso Y
Department of Urology, Faculty of Medicine, University of Tokyo.
Nihon Hinyokika Gakkai Zasshi. 1993 Feb;84(2):313-21. doi: 10.5980/jpnjurol1989.84.313.
Adrenalectomy for Cushing's syndrome due to adrenocortical adenoma was performed on 40 patients at Tokyo University Hospital between 1960 and 1990. There were 32 women and 8 men aged 2 to 59 (mean 35.7) years. Three different operative approaches to the adrenal gland were employed: lumbar approach in 24 cases, dorsal in 8, and transabdominal in 8 of whom 7 patients were operated before 1970 without definite preoperative localization of the lesions. Postoperative administration of cortisone and hydrocortisone as a steroid replacement has been reduced in duration and dosage in recent 10 years. Average treatment period was 3 years and 1 month in the 1970's, and 9.5 months in the 1980's, respectively. The mean daily dosage of steroid hormone was 517.5 mg (mean) on the operative day and 43.1 mg after three weeks in the 1970's, while 187.5 mg and 18.4 mg in the recent five years, respectively. Nonetheless, even in the recent 6 patients, metabolic alkalosis and hypopotassemia because of steroid excess were observed in a few days after the surgery. These observations indicate that period and dosage of steroid replacement have been reduced in these years and could be further shortened by means of rapid tapering in the early postoperative phase.
1960年至1990年间，东京大学医院对40例因肾上腺皮质腺瘤导致库欣综合征的患者实施了肾上腺切除术。患者年龄在2至59岁（平均35.7岁）之间，其中女性32例，男性8例。采用了三种不同的肾上腺手术入路：24例采用腰部入路，8例采用背部入路，8例采用经腹入路，其中7例患者在1970年之前接受手术，术前未明确病变定位。近10年来，作为类固醇替代药物的可的松和氢化可的松的术后给药时间和剂量有所减少。20世纪70年代的平均治疗期为3年1个月，80年代为9.5个月。20世纪70年代，手术当天类固醇激素的平均每日剂量为517.5毫克（平均），术后三周为43.1毫克，而最近五年分别为187.5毫克和18.4毫克。尽管如此，即使在最近的6例患者中，术后几天仍观察到因类固醇过量导致的代谢性碱中毒和低钾血症。这些观察结果表明，近年来类固醇替代的时间和剂量有所减少，并且通过术后早期快速减量可以进一步缩短。
