Chapuis Y, Pitre J, Conti F, Abboud B, Pras-Jude N, Luton J P
Department of General and Digestive Surgery, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France.
World J Surg. 1996 Sep;20(7):775-9; discussion 779-80. doi: 10.1007/s002689900118.
Transsphenoidal pituitary surgery has radically modified the management of pituitary-dependent hypercortisolism (Cushing's disease). Bilateral adrenalectomy may, however, represent the ultimate treatment in some cases of hypercortisolism. In the present study we report our experience of bilateral adrenalectomy in 82 patients operated on during the last 15 years. The causes of hypercortisolism were Cushing's disease (n = 78), ectopic ACTH syndrome (n = 3), and primary adrenocortical nodular dysplasia (Carney-Meador syndrome) (n = 1). Before operation 37% of the patients had severe symptoms of hypercortisolism. A bilateral posterior approach was undertaken in 58 patients, whereas 18 patients had an anterior transabdominal approach and 6 patients a laparoscopic approach. There were two operative deaths (2.4%). Postoperative complications occurred mostly in cases of advanced disease and were observed in 14 patients (17%), among whom 4 had severe complications. At long-term follow-up, one recurrence of hypercortisolism and 12 Nelson syndromes (15%) were observed. In conclusion, bilateral adrenalectomy carries an acceptable operative risk, and we recommend bilateral adrenalectomy rather than long-term suppressive therapy in patients requiring prompt and definitive control of their hypercortisolism or after pituitary surgery failure.
经蝶窦垂体手术已从根本上改变了垂体依赖性皮质醇增多症（库欣病）的治疗方式。然而，双侧肾上腺切除术在某些皮质醇增多症病例中可能是最终的治疗方法。在本研究中，我们报告了过去15年中82例接受双侧肾上腺切除术患者的经验。皮质醇增多症的病因包括库欣病（n = 78）、异位促肾上腺皮质激素（ACTH）综合征（n = 3）和原发性肾上腺皮质结节性发育异常（卡尼 - 米多尔综合征）（n = 1）。术前，37%的患者有严重的皮质醇增多症症状。58例患者采用双侧后路手术，18例患者采用经腹前路手术，6例患者采用腹腔镜手术。有2例手术死亡（2.4%）。术后并发症大多发生在疾病晚期，14例患者（17%）出现并发症，其中4例有严重并发症。在长期随访中，观察到1例皮质醇增多症复发和12例尼尔森综合征（15%）。总之，双侧肾上腺切除术具有可接受的手术风险，对于需要迅速且明确控制皮质醇增多症或垂体手术失败后的患者，我们建议采用双侧肾上腺切除术而非长期抑制治疗。
