| Objective:Retroperitoneal laparoscopic adrenalectomy often has a good curative effect in treating aldosterone-producing adenoma. Pre-operative biochemical abnormalities such as high aldosterone and low-potassium among patients would recover in a short period of time after operation and most of symptoms may disappear. However, it is also found that some patients with pre-operative hypertension fail to return to normal. In this research, we retrospectively analyzed the short-term and long-term efficacy of retroperitoneal laparoscopic adrenalectomy among patients with aldosterone producing-adenoma and discussed factors affecting post-operative recovery of hypertension, thus helping clinicians predict preoperatively the effect for the recovery of blood pressure after operative treatment.Methods:The clinical data on a total of 55 patients who were confirmed with unilateral aldosterone producing-adenoma and hypertension by biochemical, imaging and pathological examinations and underwent retroperitoneal laparoscopic unilateral adrenalectomy at the urinary surgery of Qilu Hospital of Shandong University from January 2012 to February 2015. These patients were divided into normal blood pressure group and high blood pressure group according to blood pressure recovery after operation. Differences in age, gender, BMI, history of hypertension, family history of hypertension, number of hypotensive drugs required to control pre-operative blood pressure, pre-operative renal function, echocardiogram results, size of tumor, serum potassium, plasma aldosterone concentration and renin concentration between these two groups were assessed. Univariate analysis was carried out for each factor observed, then multivariate analysis was performed for suspicious risk factors, and finally the value of each index in predicting post-operative blood pressure was explored. Statistical significance was set at P<0.05. The clinical efficacy of retroperitoneal laparoscopic unilateral adrenalectomy for the treatment of aldosterone producing-adenoma was discussed.Results:1.55 patients successfully underwent retroperitoneal laparoscopic total adrenalectomy on the affected side, with no case requiring conversion to open surgery, no case with intraoperative and postoperative blood transfusion, and no case reporting postoperative complications. The mean operating time was (96.29±23.87)min, the mean duration of postoperative indwelling drainage tube was (3.73±1.04)d, and the mean postoperative length of stay was (5.87±1.94)d.2.18 cases suffered from headache and dizziness before operation, but these symptoms disappearedin 14 cases, relieved in 3 cases, and no improvement was noted in 1 case after operation.23 cases suffered from asthenia and intermittent weakness in the limbs before operation, but these symptoms disappeared in 22 cases and relieved in 1 case after operation.24 cases suffered from diuresis, nocturia and polydipsia before operation, but these symptomsdisappeared in 23 cases and relieved in 1 case with diabetes after operation.6 cases suffered from limbs anesthesia before operation, but these symptoms disappeared in all cases. A total of 42 cases had hypokalemia before operation, all of them were cured after treatment with spirolactone before operation, and their serum potassium levels returned to normal one week after operation.3.The blood pressure of 29 cases returned to normal after operation. Among them,21 cases returned to normal within 1 month after operation and 8 cases within 1 month to 12 months. The blood pressure of 26 cases failed to return to normal within 1 year after operation. Among them,23 cases was improved, but 3 cases had no significant improvement.4.Univariate and multivariate analyses indicated that course of hypertension, age, color Doppler echocardiography and left ventricle hypertrophy or not played a role in predicting the improvement in patients’ hypertension. According to Aldosteronoma Resolution Score (ARS), the area under the ROC curve was 0.732, showing statistical significance as indicated by test. It was of predictive value for the recovery of hypertension after operation.ConclusionRetroperitoneal laparoscopic unilateral adrenalectomy serves as a safe and effective method in treating aldosterone-producing adenoma combined with hypertension. A study of patients’ prognosisfind that patient’s course of hypertension, age and left ventricle hypertrophy or not have statistical significance in the improvement of hypertension after operation. Old-aged patients at operation, patients with long course of hypertension and existing left ventricle hypertrophy before operation should be informed of the possibility that blood pressure may not be controlled after operation. ARS has a predicative value for whether patient’s hypertension can recover after operation. |
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