检验医学与临床
檢驗醫學與臨床
검험의학여림상
Laboratory Medicine and Clinic
2015年
18期
2674-2676,2679
,共4页
刘文聪%王德林%程庆丰%张鑫%李美才%张尧%蒲军%何云锋%吴小候%李启富%何江
劉文聰%王德林%程慶豐%張鑫%李美纔%張堯%蒲軍%何雲鋒%吳小候%李啟富%何江
류문총%왕덕림%정경봉%장흠%리미재%장요%포군%하운봉%오소후%리계부%하강
醛固酮增多症%典型%不典型%诊断%治疗
醛固酮增多癥%典型%不典型%診斷%治療
철고동증다증%전형%불전형%진단%치료
hyperaldosteronism%typical%atypical%diagnosis%treatment
目的：回顾性总结原发性醛固酮增多症（PHA）的诊断及治疗经验。方法选取2009年1月至2013年12月重庆医科大学附属第一医院诊断为 PHA 患者84例，根据临床表现、血钾、24 h 尿钾、血气分析、立位醛固酮与肾素比值（ARR）、肾上腺静脉取血（AVS）、卡托普利抑制试验、CT 定位检查及术后病理确诊为 PHA ，采用后腹腔镜肾上腺肿瘤切除术治疗，将患者分为典型临床表现组和不典型临床表现组；比较两组患者肿瘤大小、术前美国麻醉师协会（ASA）分级、手术时间、术中出血量、术前准备时间、术后住院时间。结果典型组与不典型组肿瘤最大径、手术时间、术后住院时间、术中出血量比较，差异无统计学意义（P＞0．05）；典型组和不典型组术前准备时间、术前 ASA 分级比较，差异有统计学意义（P＜0．05）。结论典型和不典型 PHA 诊断及治疗无差别；典型组较不典型组手术风险高，需要较长的术前准备时间；AVS 适用于早期 PHA 确诊或定位困难者。
目的：迴顧性總結原髮性醛固酮增多癥（PHA）的診斷及治療經驗。方法選取2009年1月至2013年12月重慶醫科大學附屬第一醫院診斷為 PHA 患者84例，根據臨床錶現、血鉀、24 h 尿鉀、血氣分析、立位醛固酮與腎素比值（ARR）、腎上腺靜脈取血（AVS）、卡託普利抑製試驗、CT 定位檢查及術後病理確診為 PHA ，採用後腹腔鏡腎上腺腫瘤切除術治療，將患者分為典型臨床錶現組和不典型臨床錶現組；比較兩組患者腫瘤大小、術前美國痳醉師協會（ASA）分級、手術時間、術中齣血量、術前準備時間、術後住院時間。結果典型組與不典型組腫瘤最大徑、手術時間、術後住院時間、術中齣血量比較，差異無統計學意義（P＞0．05）；典型組和不典型組術前準備時間、術前 ASA 分級比較，差異有統計學意義（P＜0．05）。結論典型和不典型 PHA 診斷及治療無差彆；典型組較不典型組手術風險高，需要較長的術前準備時間；AVS 適用于早期 PHA 確診或定位睏難者。
목적：회고성총결원발성철고동증다증（PHA）적진단급치료경험。방법선취2009년1월지2013년12월중경의과대학부속제일의원진단위 PHA 환자84례，근거림상표현、혈갑、24 h 뇨갑、혈기분석、립위철고동여신소비치（ARR）、신상선정맥취혈（AVS）、잡탁보리억제시험、CT 정위검사급술후병리학진위 PHA ，채용후복강경신상선종류절제술치료，장환자분위전형림상표현조화불전형림상표현조；비교량조환자종류대소、술전미국마취사협회（ASA）분급、수술시간、술중출혈량、술전준비시간、술후주원시간。결과전형조여불전형조종류최대경、수술시간、술후주원시간、술중출혈량비교，차이무통계학의의（P＞0．05）；전형조화불전형조술전준비시간、술전 ASA 분급비교，차이유통계학의의（P＜0．05）。결론전형화불전형 PHA 진단급치료무차별；전형조교불전형조수술풍험고，수요교장적술전준비시간；AVS 괄용우조기 PHA 학진혹정위곤난자。
Objective To retrospectively summarize the experience of the diagnosis and treatment of primary hyperaldosteronism(PHA) .Methods 84 cases of PHA in the First Affiliated Hospital of Chongqing Medical Uni‐versity from January 2009 to December 2013 were selected and definitely diagnosed as PHA according to the clinical manifestations ,serum potassium ,24 h urinary potassium ,blood gas analysis ,erect position aldosterone‐to‐renin ratio (ARR) ,adrenal vein sample (AVS) ,Captopril suppression test ,CT location examination and postoperative patholog‐ical examination .The patients were treated by retroperitoneal laparoscopic adrenalectomy .The patients were divided into the typical clinical manifestation group and the atypical clinical manifestation group ;the tumor size ,preoperative ASA grades ,surgical time ,intraoperative bleeding volume ,preoperative preparation time ,postoperative hospital stay were compared between the two groups .Results The maximum tumor diameter ,surgical time ,intraoperative bleed‐ing volume ,postoperative hospital stay had no statistical differences between the typical clinical presentation group and atypical clinical presentation group (P > 0 .05) ;while the preoperative preparation time and preoperative ASA grades had statistically significant differences between the two groups(P < 0 .05) .Conclusion Typical and atypical PHA have no difference in diagnosis and treatment ;the surgical risk in the typical group is higher than that in the a‐typical group ;and longer preoperative preparation time is needed in the typical group ;AVS is suitable for the early PHA diagnosis or the case of positioning difficulty .
