目的 对于功能性肾上腺肿瘤,通过切除或部分切除患侧肾上腺,从而达到治疗的效果.与此相比,对于那些无功能的肾上腺肿瘤合并高血压的患者,行手术治疗是否有效和其手术效果值得探讨. 方法 纳入2006年1月至2011年12月复旦大学附属华山医院收治的CT考虑为良性肿瘤并行腹腔镜肾上腺切除术的无功能腺瘤和原发性醛固酮增多症伴高血压患者153例,按术前诊断不同进行分组,分析比较各组患者临床资料,探讨术后高血压疗效的相关因素分析. 结果 153例高血压中102例患者血压恢复正常水平,29例患者高血压得到改善,共131例患者术后高血压有效改善. 131例患者中原发性醛固酮增多症患者占66例,无功能腺瘤患者占46例. 21例患者术后高血压无改善,其中原发性醛固酮增多症患者占14例,无功能腺瘤患者占7例. 单因素分析发现原发性醛固酮增多症和无功能腺瘤患者术后高血压无效组的高血压病程>6年人数比例比术后高血压有效组高( P<0 .05 ) ,而年龄、性别、BMI和术前服用降压药物<3种无统计学差异. 多因素分析发现高血压发病时间是否>6年( P=0 .001 ,95%CI 9 .447~6403 .658 )为原发性醛固酮增多症和无功能腺瘤患者术后高血压无效的独立危险因素,而性别、年龄、术前服用降压药物<3种和术前是否伴有低血钾与患者术后高血压是否改善没有统计学意义. 结论 手术治疗原发性醛固酮增多症和无功能腺瘤术后高血压治愈率分别为82.5%和86.79%. 对于偶然发现的无功能肾上腺瘤,合并高血压发病时间<6年时可以考虑手术治疗. 而醛固酮增多症合并高血压发病时间>6年的患者,术前应告知患者术后高血压有不改善可能.%Objective For functionl adrenal tumors, via resection or partial resection of the affecting side ad-renal gland, so as to achieve the effect of treatment.In contrast, for those nonfunctional adrenal tumors compli-cated with hypertension, the effect of operation is worth discussing.Methods From January 2006 to December 2011 , we carried out a total of 153 patients considered as adrenal benign tumor by CT scan and performed retro-peritoneoscopic adrenalectomy.Compare with the clinical and pathological data of patients and analyzes the treatment effect related factors of retroperitoneal laparoscopic adrenalectomy.Results 153 cases accompanied with hypertension, 102 patients blood pressure returned to normal levels, 29 cases with hypertension were im-proved, a total of 131 patients with postoperative hypertension had effective improvement.Primary aldosteronism account for 66 cases, nonfunctio nal adenoma account for 46 cases.21 cases of patients with postoperative hy-pertension without improvement.Primary aldosteronism accounted for 14 cases, nonfuncti-onal adenoma ac-counted for 7 cases.Analyze the primary aldosteronism andnonfunctional adenoma group revealed that the age and the proportion of hypertension incidence>6 years of hypertension invalid group's is more than hypertension effective group (P <0.05).BMI, gender and taking preoperative antihypertensive drug <3 types were no sta-tistical significance.Logistic regression analysis showed that the hypertension incidence>6 years is independent factor of postoperative hypertension whether is effective in primary aldosteronism group ( P=0.01, 95%CI:9. 447~6403.658) and nonfunctional adenoma group (P =0.033, 95%CI:1.204~78.557), Age, gender and taking preoperative antihypertensive drug <3 types were no statistical significance.Conclusions The hyperten-sive effective rates of primary aldosteronism and nonfunctional adenoma were 82.5%and 86.79%, so we con-sider that nonfunctional adrenal tumor discovered by accident and accompanied by hypertension incidence <6 years to operation treatment.
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