| Objective:To investigate the cortisol hormone changes after unilateral laparoscopic adrenalectomy to understand the occurrence of adrenocortical insufficiency after unilateral adrenalectomy,and then to provide evidence for the application of perioperative hormones.Method:patients undergoing unilateral laparoscopic adrenalectomy in our hospital from 2017 December to 2019 December,including general patient information(gender,age),postoperative pathology,total resection and partial resection of unilateral adrenal gland,cortisol and non-cortisolism And plasma cortisol hormones at 1,3,and 7 days after surgery.Analyze trend of postoperative cortisol hormones compared with that before surgery;whether one side resection and partial resection are related to postoperative cortisol hormone changes;postoperative cortisol hormone changes,cortisolism and noncortisol increase There is no correlation between symptoms.Result:90 patients were included in the current thesis.There were 56 patients with unilateral total resection,34 patients with unilateral partial resection,10 patients with hypercortisolism,and 80 patients with noncortisolism.The preoperative cortisol concentration of 90 patients was195.20±54.32ng/ml,and the cortisol concentration was 108.99±35.62ng/ml,158.36±37.23 ng/ml,178.74±28.20 ng/ml at 1 day,3 days and 7days after operation.The general trend of postoperative cortisol hormones is: the cortisol concentration decreased significantly on the first postoperative day,gradually increased gradually on the third postoperative day,and the cortisol hormone on the seventh postoperative day was basically the same as the preoperative level.Among them,there were 10 patients with cortisol concentration higher than the preoperative level on the first postoperative day.There were 20 patients with postoperative cortisol concentration lower than the normal value of cortisol concentration.After surgery,symptoms of transient nausea and vomiting,fatigue,fatigue and hypotension occurred.The symptoms of cortisol disappeared immediately after short-term cortisol supplementation.Overall,the incidence of adrenal insufficiency after unilateral laparoscopic adrenalectomy in our thesis is approximately22.22%.The cortisol concentration of patients in the unilateral adrenalectomy in the experimental study before operation and on days 1,3,and 7 after operation was 192.28 ± 58.68 ng/ml,97.68 ± 32.54 ng/ml,142.25 ± 36.78ng/ml,172.56 ± 30.24 ng/ml,respectively.The cortisol concentration of patients in our hospital’s laparoscopic unilateral partial adrenalectomy group before operation and on days 1,3,and 7 after operation was 198.31± 57.42 ng/ml,114.68 ± 36.54 ng/ml,163.42 ± 34.65 ng/ml,183.58 ±37.48 ng/ml,respectively.After comparison between the two groups of patients,the postoperative cortisol concentration showed a significant decrease on the first postoperative day,a gradual increase on the third day,and a return to preoperative levels on the seventh day.Overall,the recovery of cortisol hormones in the unilateral laparoscopic adrenalectomy group of our hospital was faster than that of laparoscopicunilateral adrenal gland resection group.There were no statistically significant changes in postoperative hormone levels between the two groups(P=0.250).There were no statistically significant changes in postoperative hormone levels between the two groups.In laparoscopic unilateral partial adrenalectomy,6 patients developed adrenal insufficiency;in laparoscopic unilateral adrenal insufficiency,14 patients developed adrenal insufficiency.The cortisol concentration of patients in our hospital’s laparoscopic cortisol group before operation and on days 1,3,and 7 after operation was 212.28 ± 69.53 ng/ml,103.28 ± 45.31 ng/ml,153.34 ± 41.48 ng/ml,189.57 ± 43.26 ng/ml.The cortisol concentration of patients in our hospital’s laparoscopic non-cortisolism group before operation and on days 1,3,and 7 after operation was 180.16 ± 64.34 ng/ml,98.23 ± 37.42ng/ml,142.36 ± 40.85 ng/ml,171.58 ± 45.63 ng/ml.Postoperative cortisol concentration in both groups decreased significantly on the first day,slowly increased on the third day,and returned to normal levels on the seventh day.Overall,the postoperative hormone recovery rate of patients in the hypercortisol group was slower than that in the non-cortisol group.The comparison of postoperative cortisol concentration changes between the two groups was not statistically significant(P=0.180).In the laparoscopic cortisol group of our hospital,15 cases of adrenal insufficiency occurred after operation in the hospital,and 5 cases of adrenal insufficiency occurred in the non-cortisol group.Conclusion:The trend of cortisol after unilateral laparoscopic adrenalectomy was as follows: the cortisol concentration decreased significantly on the first postoperative day,gradually began to rise slowly on the third postoperative day,and the cortisol hormone on the seventh postoperativeday was basically the same as the preoperative level.There was no statistically significant difference in postoperative cortisol concentration between unilateral laparoscopic adrenalectomy and partial excision(P=0.250).There was no statistically significant difference in postoperative cortisol concentration between the hypercortisolism and non-cortisolism groups(P=0.180).The incidence of adrenal insufficiency after unilateral laparoscopic adrenalectomy in our hospital is about 22.20%. |
PDF Full Text Request