后腹腔镜治疗肾上腺腺瘤型皮质醇增多症90例

摘要

目的：探讨后腹腔镜手术结合简化激素替代方案治疗肾上腺腺瘤型皮质醇增多症的疗效。方法：对90例肾上腺腺瘤型皮质醇增多症患者行后腹腔镜手术治疗，男性18例，女性72例；年龄17~76岁，平均年龄40岁；病变位于左侧50例，右侧40例；24 h尿皮质醇132.4~2060μg/24 h，平均值（685.4±398.2）μg/24 h；血皮质醇772.5~1710.5 nmol/L，平均值（1106.3±240.0）nmol/L；行肾上腺全切术31例，肾上腺部分切除术（腺瘤切除）59例，术后辅以简化激素替代方案治疗。结果：90例患者手术全部成功，无1例输血，所有患者围手术期均没有肾上腺危象及肾上腺皮质功能不全发生。术后病理结果为肾上腺皮质腺瘤。随访5~24个月，患者临床症状均有不同程度缓解。术后12～42周后所有患者均停用激素替代治疗，其中肾上腺全切患者激素替代治疗持续时间为（19．55±2．93）周，而肾上腺部分切除患者为（17．86±2．70）周，肾上腺部分切除患者术后激素替代治疗平均持续时间较肾上腺全切短，但二者差异无统计学意义（P>0.05）。结论：行后腹腔镜肾上腺切除术结合简化激素替代治疗方案治疗腺瘤型皮质醇增多症安全、有效，肾上腺部分切除术因保留了部分有功能的肾上腺，治疗效果优于肾上腺全切术。%Objective:To evaluate the therapeutic effect of retroperitoneal laparoscopic surgery with brief hormone replacement therapy for Cushing’s syndrome with adrenal adenoma. Methods:Ninety patients (18 males and 72 females) who underwent laparoscopic surgery for Cushing’s syndrome with adrenaladenoma were enrolled in this study. The age ranged from 17 to 76 years old, with mean age of 40 years. Forty cases were on the right side and 50 cases on left side. The levels of 24 h urine cortisol was 132.4-2 060μg/24 h, and the mean value was (685.4 ± 398.2)μg/24 h;The levels of blood cortisol were 772.5-1 710.5 nmol/L, and the mean value was(1 106.3±240.0) nmol/L. Of all the cases, 31 cases underwent total adrenalectomy and 59 cases underwent adenoma resection. All the patients received the brief corticoid replacement therapy. Results:All patients were followed up to 5 to 24 months. The clinical symptoms relieved in various degrees and no postoperative adrenal insufficiency phenomenon occured. All patients ceased receiving hormone replacement therapy at 12-42 weeks post surgery. The duration of hormone replacement therapy for patients who underwent adenoma resection was shorter than the patients who underwent total adrenalectomy [(19.55 ±2.93) weeks vs (17.86 ±2.70) weeks], but no statistical significance (P>0.05). Conclusion: Retroperitoneal laparoscopic adrenalectomy with brief corticoid replacement therapy for Cushing’s syndrome with adrenaladenoma is safe and feasible. Partial adrenalectomy is better than total adrenalectomy because it maintains more functional adrenal tissues.