To Compare The Method On Determining The Functional Location And Clinical Effects Of Two Operation Methods In Paitients With Primary Hyperaldosteronism

Objective To compare the role on determining the functional location of primary hyperaldosteronism(PHA)by multi-slice spiral CT(MSCT)and by adrenal vein sampling(AVS),and to discuss the reasonable method to use MSCT and AVS in localization diagnosis of PHA.Methods Clinical data of 78 patients with PHA were analyzed retrospectively.These patients were diagnosed in our department from June2014 to June 2018;there were 27 male and 51 female patients;the mean age was(47.5±11.2)years;the mean systolic blood pressure was(190±24)mm Hg,the mean diastolic blood pressure was(111±16)mm Hg,the mean duration of hypertension was(6.0±6.0)years;the mean serum potassium was(2.4±0.6)mmol/l;the mean plasma aldosterone concentration(PAC)was(415.68±235.37)pg/ml,the mean plasma renin activity(PRA)was(3.2±5.7)ng/ml/h,the mean aldosterone/renin ratio(ARR)was(409.00±434.91)? All PHA patients underwent MSCT and AVS,the accuracy on determining the functional location of PHA by MSCT and by AVS were evaluated by pathology results;the influence of adrenal size and character on the accuracy on determining the functional location of PHA by MSCT were analyzed.Results The rate of accuracy on determining the functional location of PHA by AVS was higher than that by MSCT[100%(78/78)vs 71.8%(56/78),P<0.05].When MSCT indicated: adrenal hyperplasia,adrenal tumor volume ?1cm,1cm < adrenal tumor volume?2cm,adrenal tumor volume>2cm,the rate of accuracy in localization diagnosis with MSCT was 50%(4/8),81%(17/21),92.9%(26/28),100%(9/9)respectively.Its trend has statistical significance(p<0.05).The diagnostic accuracy rate of MSCT for aldosterone adenoma was 79.6%(43/54),while that of adrenal hyperplasia was 58.3%(7/12),there was no statistical significance between two diagnostic accuracy rate of MSCT(p>0.05).Conclusion AVS is the gold standard for localization diagnosis;When MSCT indicates that there is no obvious abnormality in the adrenal gland,adrenal hyperplasia,small tumor(?2cm),and bilateral adrenal lesions,AVS should be examined at the same time,as the gold standard for localization diagnosis.For isolated adrenal tumor(> 2cm)in PHA,the accuracy of localization diagnosis in MSCT is very high,and AVS is unnecessary.Objective To compare the clinical effects of two operation methods for aldosterone-producing adenomas(APA),retroperitoneal laparoscopic adrenalectomy and adrenal tumor resection,by analyzing relevant parameters used to evaluate operation effect.Methods Clinical data of 103 patients with APA were analyzed retrospectively.These patients were diagnosed in the First Affiliated Hospital of Chongqing Medical University from January 2014 to September 2018 ? All patients underwent retroperitoneal laparoscopic surgery.32 patients(31.1%)underwent adrenalectomy,71 patients(68.9%)underwent adrenal tumor resection.Perioperative data,postoperative blood pressure and recurrence rate were compared between the two groups.Results The mean operative time with adrenalectomy was longer than that with adrenal tumor resection.[(117±47)min vs(78±32)min,P<0.05 ].The rate of perioperative complications with adrenalectomy was higher than that with adrenal tumor resection [9.4%(3/32)vs 0(0/71),P<0.05].The mean time stay in hospital with adrenalectomy was longer than that with adrenal tumor resection.[(5.2±3.1)days vs(4.0±1.1)days,P < 0.05 ].There were no significant differences in the mean blood loss,mean drainage time,the incidence of cortisol deficiency(P>0.05).all patients were followed up for 6 to 41 months,15.7 months in average.there was no significant difference in the improvement rate of blood pressure after operation between two groups(P>0.05).The rate of tumor recurrence with adrenalectomy was 0%(0/32),The tumor recurrence of adrenal tumor resection was 4.2%(3/71).Conclusions There were no difference between retroperitoneal laparoscopic adrenalectomy and adrenal tumor resection in efficacy and safety for treatment of aldosterone producing adenomas;Compared with adrenalectomy,adrenal tumor resection can preserve the adrenal function despite the possibility of postoperative recurrence,and the recurrence is a low probability event.Even if the recurrence happened,it is relatively easy to perform the operation with laparoscopy via abdominal approach.Therefore,any one of the operative methods can be selected according to the specific situation in clinical work.