摘要
目的:探讨原发性醛固酮增多症的诊断及治疗。方法:回顾性分析63例原发性醛固酮增多症患者的临床资料。结果:63例均有不同程度高血压,低钾者58例,通过测定外周血及肾上腺静脉血的激素水平,19例为原发性醛固酮增多症腺瘤型,14例为肾上腺增生。19例腺瘤型直接行腹腔镜肾上腺切除术,增生及其余行外周血及肾上腺静脉取血检查,优势侧肾上腺静脉醛固酮-皮质醇之比除以弱势侧肾上腺静脉醛固酮-皮质醇之比>2,同时外周静脉醛固酮水平高于0.520 5pmol/L,醛固酮/肾素活性比值≥40者共41例行腹腔镜肾上腺切除术。经治疗后57例患者血压及血钾均有不同程度的恢复,术后病理检查提示腺瘤19例、微腺瘤21例、结节样增生17例。结论:原发性醛固酮增多症主要通过影像学检查定位,外周血及肾上腺静脉取血测定激素水平定性诊断。腹腔镜下肾上腺腺瘤切除仍是当前的首选治疗方法,外周血及肾上腺静脉取血测定是早诊断、早治疗,预防疾病进一步发展的关键。
Objective： To study the diagnosis and treatment of primary-aldosteronism（PA）. Methods： Clinical data of 63 patients diagnosed as primary aldosteronism were retrospectively analysed. Results： All patients appeared with arterial hypertension in different degree, 58 cases were with hypokalemia, 19 patients were aldosteronism al- dosterone-producing adenoma and 14 patients were adrenal hyperplasia respectively by the determination of hor- mone levels that peripheral blood and adrenal venons blood. The 19 eases with aldosterom producing adenoma un- derwent laparoscop adrenalectomy. The rest measured peripheral and adrenal venous sampling, and the results of 41 eases were that the adrenal vein aldosterone-cortisol ratio of the dominant side to the weaker side ratio~ 2,and pe- ripheral venous aldosterone levels above 0. 520 5 pmol/L, and plasma aldosterone to renin ratio 940, so they un- derwent laparoscop adrenalectomy too. The symptoms of primary aldosteronism were ameliorated to various ex- tents in 57 cases after treatment. Histopathologieal examination confirmed adrenal adenoma in 19 patients, adrenal micro-adenoma in 21 patients and adrenal nodular hyperplasia in 17 patients. Conclusions： Primary aldosteronism was diagnosised by adrenal imaging examination and the measurement of the hormone levels of peripheral and adre- nal venous sampling. Laparoscopic adrenalectomy is the preferred surgical approach for adrenal adenoma,and the measurement of hormone levels of peripheral and adrenal venous sampling was the key of early diagnosis, early treatment and prevention of disease progression.
出处
《临床泌尿外科杂志》
2012年第5期357-359,362,共4页
Journal of Clinical Urology
