CAJ | 학술논문

目的：探讨氢化可的松在后腹腔镜下手术治疗皮质醇增多症围手术期激素替代中的应用及效果。方法56例皮质醇增多症患者在后腹腔镜手术治疗围手术期应用氢化可的松激素替代方案治疗，术前不用激素，术中及术后第1、2天予静滴氢化可的松，从第2天开始口服氢化可的松，并逐渐减量至维持治疗。术后密切观察临床症状，并间断监测血、尿皮质醇来评价该激素替代治疗效果。结果2例术后出现轻微皮质功能不全症状，予加大口服剂量后症状消失；6例血皮质醇（cortisol，Cor）低于正常范围，未出现皮质功能低下症状，其同天尿Cor均在正常范围内。术后第7天尿皮质醇与术前相比明显降低，差异有统计学意义；术后第6、7天血皮质醇与术前相比明显降低，差异有统计学意义。患者术后均未出现伤口感染，恢复良好。结论氢化可的松在后腹腔镜下治疗皮质醇增多症患者围手术期激素替代治疗中是安全可行的。
목적：탐토경화가적송재후복강경하수술치료피질순증다증위수술기격소체대중적응용급효과。방법56례피질순증다증환자재후복강경수술치료위수술기응용경화가적송격소체대방안치료，술전불용격소，술중급술후제1、2천여정적경화가적송，종제2천개시구복경화가적송，병축점감량지유지치료。술후밀절관찰림상증상，병간단감측혈、뇨피질순래평개해격소체대치료효과。결과2례술후출현경미피질공능불전증상，여가대구복제량후증상소실；6례혈피질순（cortisol，Cor）저우정상범위，미출현피질공능저하증상，기동천뇨Cor균재정상범위내。술후제7천뇨피질순여술전상비명현강저，차이유통계학의의；술후제6、7천혈피질순여술전상비명현강저，차이유통계학의의。환자술후균미출현상구감염，회복량호。결론경화가적송재후복강경하치료피질순증다증환자위수술기격소체대치료중시안전가행적。
Objective To investigate the application and effect of hydrocortisone during perioperation of retroperitoneum laparoscopic surgery for Cushing's syndrome.Methods Data of 56 cases of Cushings's syndrome treated by hormone replacement therapy of hydrocortisone were retrospectively analyzed .The hormone replacement therapy was as the following:no hormone before surgery, intravenous drip of hydrocortisone during and the 1st and 2nd day after surgery, oral intake of hydrocortisone from the 2nd after surgery.Clinical symptoms were observed and plasma,24h urine cortisol levels were intermittently measured after the surgery to evaluate the effects of treatment . Results 2 cases had slight cortical dysfunction symptoms, then back to normal after receiving larger dose of hydro-cortisone.6 cases had blood cortisol levels below the normal range , but they did not have cortical dysfunction symp-toms, and at the same time their 24h urine cortisol levels were normal .Urine cortisol concentration significantly de-creased on the 7th day after surgery, and had significant difference compared with that before surgery .Plasma cortisol concentration significantly decreased on the 6th, 7th day after surgery, and had significant difference compared with that before operation.All the cases recovered well.Conclusion Perioperative hydrocortisone replacement in retroper-itoneum laparoscopic surgery for Cushing's syndrome is safe.