肾上腺单侧切除术治疗复杂性库欣病10例报告
Unilateral adrenalectomy for the treatment of refractory or recurrent Cushing disease: report of 10 cases
目的 探讨肾上腺单侧切除术治疗难治性和复发性库欣病的临床疗效. 方法 回顾性分析2003年1月至2011年7月10例行肾上腺单侧切除的复杂性库欣病患者的临床特点、术前治疗情况、手术情况和随访结果.10例术前均存在高皮质醇血症及高皮质血症所导致的多种严重的代谢并发症.9例术前行经蝶窦垂体肿瘤切除术,8例有垂体放射治疗史.10例均行右侧肾上腺切除术. 结果 无手术相关的严重并发症发生.术后随访1~8年,8例有垂体区放疗史患者术后临床症状缓解满意,未行激素替代治疗,未出现Nelson综合征.2例无垂体放疗史患者因临床症状缓解不满意,为控制相关并发症,再次手术切除对侧肾上腺. 结论 单侧肾上腺切除可选择性应用于术前进行过垂体放射治疗的难治性及复发性库欣病病例,能比较有效地缓解高皮质醇血症导致的并发症.由于保留了对侧肾上腺,避免了双侧肾上腺切除所导致的终身皮质激素替代治疗和肾上腺皮质危象,并可防止发生Nelson综合征.
更多Objective To discuss the value of unilateral adrenalectomy(UA)for the treatment of refractory or recurrent Cushing disease(RRCD).Methods From January 2003 to July 2011,10 patients with RRCD underwent UA.The preoperative symptoms,preoperative treatments,intra-and post-operative complications and follow-up in patients were reviewed.All the 10 patients presented with hypercortisolemia symptoms.Transsphenoidal surgery had been performed in 9 patients as initial therapy.Of the 10 patients,8 received radiation therapy before adrenalectomy.All the 10 cases accepted a right UA.Results No perioperative complications occurred.The 10 patients were followed up for 1-8 years.Eight patients with radiation therapy before adrenalectomy got remission.Two bilateral adrenalectomies were eventually performed because the symptoms could not be controlled.Of the 8 patients who got remission,none of them developed Nelson syndrome and none need lifelong mineralocorticoid and glucocorticoid replacement therapy.Conclusions UA could be an option for RRCD.For patients with RRCD receiving radiation therapy,UA may effectively relief hypercortisolemia.Compared with bilateral adrenalectomies,UA could avert permanent adrenal insufficiency,which leads to a lifelong glucocorticoid and mineralocorticoid replacement therapies,and a life-threatening adrenal crisis.
More- 浏览:502
- 被引:4
- 下载:196
相似文献
- 中文期刊
- 外文期刊
- 学位论文
- 会议论文