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目的探讨肾上腺结节样肿物合并难治性高血压的诊断与外科治疗经验。方法总结67例肾上腺结节样肿物合并难治性高血压患者的发病年龄、临床表现、相关内分泌检查、影像与病理特点以及手术治疗后的相关变化。本组67例,年龄28～63岁,平均37.8岁,均有高血压病史,平均收缩压(196±33)mmHg,平均舒张压(127±15)mmHg。病程5～240个月,平均65.2个月。肾上腺结节样肿物位于左侧37例,右侧26例,双侧4例。血K+﹤3.5mmol/L者43例。肾素-血管紧张素-醛固酮(ACTH)异常60例,3-甲氧基4-羟基扁桃酸(VMA)异常24例,7例内分泌学的检查均正常。CT或MRI显示肾上腺结节样肿物直径0.3～2.0cm。结果本组患者均行腹腔镜患侧肾上腺结节样肿物切除、肾上腺部分切除术或全部切除治疗。病理检查肾上腺皮质结节样增生28例,肾上腺皮质腺瘤39例。术后血钾、24h尿钾、血肾素醛固酮均恢复正常,术后6个月肾上腺皮质腺瘤组平均收缩压为(127±11)mmHg、平均舒张压为(80±7)mmHg,肾上腺皮质增生组平均收缩压为(135±12)mmHg、平均舒张压为(90±9)mmHg,较术前均有明显下降。结论利用腹腔镜手术行患侧肾上腺部分切除术或全部切除治疗肾上腺结节性肿物合并难治性高血压是安全、可行和有效的方法。
Objective To investigate the diagnosis and surgical treatment of adrenal nodular masses with refractory hypertension. Methods The age, clinical manifestations, related endocrine examination, imaging and pathological features of 67 adrenal nodular masses with refractory hypertension were summarized and the related changes after surgery were summarized. The group of 67 patients, aged 28 to 63 years, mean 37.8 years, have a history of hypertension, the average systolic blood pressure (196 ± 33) mmHg, mean diastolic blood pressure (127 ± 15) mmHg. Duration of 5 to 240 months, an average of 65.2 months. Adrenal nodules were located in the left side of the 37 cases, 26 cases of right and bilateral in 4 cases. Blood K + <3.5mmol / L in 43 cases. There were 60 cases of abnormal angiotensin-aldosterone (ACTH), 24 cases of abnormal 3-methoxy 4-hydroxymandelic acid (VMA), and 7 cases of endocrinology were normal. CT or MRI showed adrenal nodular tumor diameter 0.3 ~ 2.0cm. Results All patients underwent laparoscopic ipsilateral adrenal nodules resection, partial adrenalectomy or total resection. Pathological examination adrenal nodular hyperplasia in 28 cases, 39 cases of adrenal cortical adenoma. Postoperative serum potassium, 24h urine potassium, blood renin aldosterone returned to normal after 6 months of adrenocortical adenoma average systolic blood pressure (127 ± 11) mmHg, mean diastolic blood pressure (80 ± 7) mmHg, adrenal The average systolic blood pressure in the cortical hyperplasia group was (135 ± 12) mmHg and the average diastolic pressure was (90 ± 9) mmHg, which was significantly lower than that before the operation. Conclusion Laparoscopic surgery for partial ipsilateral adrenalectomy or total resection of adrenal nodules with refractory hypertension is a safe, feasible and effective method.