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目的:探讨肾上腺醛固酮瘤术后肾功能不全原因,为肾上腺醛固酮瘤术前评估和术后治疗提供依据。方法:对我院2013年9月~2015年3月间明确诊断为醛固酮瘤并行手术治疗的42例患者进行回顾性分析。其中男24例,女18例。年龄30~69岁,平均(45±4.8)岁。根据术后有无出现肾功能不全分为术后肾功能正常组和术后肾功能不全组。术前均行血尿常规、肝肾功能、电解质、相关激素及双侧肾上腺CT薄层扫描等常规检查,术后定期复查血压、肾功能、电解质及血醛固酮。所有患者均行腹腔镜手术,其中28例行单侧肾上腺部分切除术,14例行单侧肾上腺切除术。结果:术前肾功能检查血清肌酐均在正常范围,术后经过平均9(3~18)个月的随访,13例(30.9%)的患者术后出现肾功能不全。该组患者的术前醛固酮水平明显高于术后肾功能正常组(P<0.05),高血压病程也明显长于术后肾功能正常组(P<0.05)。结论:醛固酮瘤病程及术前醛固酮水平是影响术后肾功能不全的重要因素。
Objective: To investigate the causes of postoperative renal insufficiency of adrenal aldosteronoma and to provide the basis for preoperative evaluation and postoperative treatment of adrenal aldosterone neoplasm. Methods: A retrospective analysis was performed on 42 patients with concurrent diagnosis and treatment of aldosterone in our hospital from September 2013 to March 2015. There were 24 males and 18 females. Age 30 to 69 years, mean (45 ± 4.8) years. According to the presence or absence of postoperative renal insufficiency was divided into normal renal function group and postoperative renal insufficiency group. Preoperative routine hematuria, liver and kidney function, electrolytes, related hormones and bilateral adrenal CT thin-layer scanning and other routine examination, regular review of blood pressure, renal function, electrolyte and serum aldosterone. All patients underwent laparoscopic surgery, of which 28 cases of unilateral partial adrenalectomy, 14 cases of unilateral adrenalectomy. Results: Preoperative serum creatinine in renal function tests were in the normal range. After an average of 9 months (3-18 months) follow-up, 13 patients (30.9%) had renal dysfunction after operation. The preoperative aldosterone level in this group was significantly higher than that in the normal renal function group (P <0.05). The course of hypertension was also significantly longer than that in the normal renal function group (P <0.05). Conclusion: The course of aldosteronoma and the preoperative aldosterone level are the important factors that affect postoperative renal insufficiency.