CAJ | 학술논문

目的：探讨促肾上腺皮质激素（adrenocorticotropic hormone，ACTH）非依赖性库欣综合征患者术后激素替代治疗的方案及效果。方法选取本院2010年2月至2014年2月收治的ACTH非依赖性库欣综合征患者52例为研究对象，其中单侧肾上腺腺瘤47例，行单侧肾上腺切除术；双侧肾上腺大结节样增生5例，行一侧肾上腺切除＋对侧次全切除术。围术期常规予以简化的激素替代治疗方案：术中静脉给予甲泼尼龙80 mg，术后1～3天静脉给予甲泼尼龙60、40、20 mg，术后第4天改为口服泼尼松片20 mg，每周递减5 mg直至维持剂量。结果截至本次随访周期，47例单侧肾上腺切除患者中42例停止激素替代治疗，平均替代治疗时间为6.5个月（3～15个月），5例双侧肾上腺手术患者中3例停止激素替代治疗，平均替代治疗时间为32个月（22～47个月）。结论简化的激素替代治疗方案能有效避免激素撤退综合征的发生，是ACTH非依赖性库欣综合征患者术后激素替代治疗简单和有效的方法。
목적：탐토촉신상선피질격소（adrenocorticotropic hormone，ACTH）비의뢰성고흔종합정환자술후격소체대치료적방안급효과。방법선취본원2010년2월지2014년2월수치적ACTH비의뢰성고흔종합정환자52례위연구대상，기중단측신상선선류47례，행단측신상선절제술；쌍측신상선대결절양증생5례，행일측신상선절제＋대측차전절제술。위술기상규여이간화적격소체대치료방안：술중정맥급여갑발니룡80 mg，술후1～3천정맥급여갑발니룡60、40、20 mg，술후제4천개위구복발니송편20 mg，매주체감5 mg직지유지제량。결과절지본차수방주기，47례단측신상선절제환자중42례정지격소체대치료，평균체대치료시간위6.5개월（3～15개월），5례쌍측신상선수술환자중3례정지격소체대치료，평균체대치료시간위32개월（22～47개월）。결론간화적격소체대치료방안능유효피면격소철퇴종합정적발생，시ACTH비의뢰성고흔종합정환자술후격소체대치료간단화유효적방법。
ObjectiveTo investigate the method and effect of steroid replacement following adrenalectomy in patients with adrenocorticotropic hormone (ACTH) independent Cushing's syndrome.MethodFrom February 2010 to February 2014, a total of 52 cases of ACTH independent Cushing’s syndrome patients were received in our department. Among these cases, 47 cases were unilateral adenoma and underwent unilateral laparoscopic adrenalectomy, the rest 5 cases macronodular adrenal hyperplasia (AIMAH) underwent unilateral adrenalectomy and contralateral subtotal adrenalectomy. The brief postoperative steroid replacement was used, 80 mg methylprednisolone was given during operation, then 60 mg, 40 mg, 20 mg on the next three days. Oral prednisolone (20 mg) was used instead of intravenous drug from the 4th day, followed by a reduction of 5 mg every week until a maintenance dosage (5~10 mg) was reached.ResultAmong 47 cases of unilateral adenoma, 42 patients ifnished steroid replacement with a mean time of 6.5 (3~15) months. Among 5 cases of AIMAH, 3 patients ifnished steroid replacement with a mean time of 32 (22~47) months.ConclusionThe brief postoperative steroid replacement can effectively avoid the occurrence of steroid withdrawal syndrome, is a brief and effective method for patients with ACTH independent Cushing's Syndrome.