Clinical Study Of Surgical Treatment Of Adrenal Tumor Complicated With Hypertension

Objective:The clinical characteristics of patients with adrenal tumor complicated with hypertension were retrospectively analyzed to provide reference for the diagnosis and treatment of adrenal tumor complicated with hypertension.Methods:Retrospective analysis of the patients with adrenal tumors between January2017 and June 2021 in our department,especially analyzed the patients who had hypertension and surgical treatment of adrenal tumors,from the patient’s age,location,and the long diameter of the tumors,and the pathologic types and so on each perspective on the improvement of their general rules and postoperative blood pressure,Patients were followed up for 1 month,2 months,6 months and 12 months.To summarize and analyze the adrenal dysfunction after adrenal tumor operation.Results:The clinical data of 233 patients with adrenal tumor were collected: 196 cases underwent operation,145 cases complicated with hypertension,and 120 cases complicated with hypertension underwent operation.The clinical data of 196 patients with adrenal tumor undergoing operation were classified.38 patients had aldosterone adenoma.The average length and diameter of the tumor was 1.80±0.56 cm,and the largest number was 1 2cm.The average length and diameter of 8 patients with cortisoloma was 3.66±0.81 cm,and the largest number was 3 4cm.The average diameter of pheochromocytoma was 3.71±0.83 cm in 12 cases,and the largest number was 3 4cm.The average length and diameter of 138 nonfunctional tumors were2.86±1.47 cm,and the largest number was 2 3cm.Among the 120 patients with adrenal tumor complicated with hypertension,51 were male and 69 were female,with a male/female ratio of 1:1.35,there were 50 patients with improved postoperative blood pressure,the improvement rate was 41.7%,the age range of patients was 21 to72 years old,the average age was 51.32±10.78 years old,and the number of patients between 41 and 60 years old was the largest.There was no correlation between postoperative blood pressure improvement in different age groups（P > 0.05）.The tumor was located in the left adrenal gland in 73 cases,and the blood pressure improved in 34 cases.There were 47 cases with tumors located in the right adrenal gland,and postoperative blood pressure improved in 16 cases.There was no significant correlation between postoperative blood pressure improvement of different tumor sides（P > 0.05）.The length and diameter of the tumor ranged from 0.6cm to12 cm,and the average size of the tumor was 2.59±1.44 cm.The number of patients with tumor length and diameter ranged from 1cm to 4cm.There was no significant difference between different groups of tumor length and postoperative blood pressure improvement rate（P > 0.05）.Among the 120 patients with hypertension,there were70 cases without functional tumor and 22 cases with improved blood pressure after operation,and 50 cases with functional tumor and 28 cases with improved blood pressure after operation,showing significant difference between them（P < 0.05）.Of50 cases of hypertension patients with functional adrenal tumors,no clear genetic history of familial hypertension,aldosterone adenoma 35 cases,all patients were followed up for 6 months,only 28 patients were followed up for 1 year,none of the28 patients Newly improved,on the contrary,there were 2 patients with recurrent hypertension,but no tumor recurrence was found in reexamination;6 cases of cortisoloma and 9 cases of pheochromocytoma were followed up for 1 year.The most obvious period of blood pressure improvement after operation for the three functional tumors was in the hospital,but some patients still improved blood pressure Out of the hospital.There was no significant difference in blood pressure improvement among the three functional tumors（P > 0.05）.Surgical treatment of aldosterone adenoma can effectively improve hypertension,and the mean systolic blood pressure and mean diastolic blood pressure of patients gradually decreased and tended to be stable over time.Moderate to severe hypertension was As the main part of the hypertension witch due to aldosterone adenoma,while mild hypertension was the main part of cortisol adenoma.Systolic blood pressure（P < 0.05）and diastolic blood pressure（P < 0.05）were different between them.Line function of 138 patients without tumor,total adrenal resection method in 32 cases,all of them,and in 3 cases of adrenal function is low,with 106 cases of partial adrenal resection,postoperative there are 1 case of adrenal function is low,the two types of surgery have obvious difference in low adrenal function（P < 0.05）;38 cases of aldosterone adenoma,there are 13 cases of adrenal full cut method,in 2 cases of adrenal function is low,partial adrenal resection in 25 cases,no patient developed adrenal hypofunction after surgery,the two types of surgery also have obvious difference in low adrenal function（P < 0.05）.Conclusions:Adrenal tumor complicated with hypertension was more common in females than in males,the left side was more common than the right side,and the length of tumor was 1 4cm.The postoperative blood pressure of functional adrenal tumors was significantly improved compared with that of non-functional adrenal tumors（P < 0.05）.Aldosterone adenoma was the most common functional tumor,almost all patients with aldosterone adenoma were accompanied by hypertension（92.1%）,and blood pressure of most patients was improved after surgery（85.7%）;patients who failed to improve or relapsed were considered to have essential hypertension.In patients without functional adrenal tumor,blood pressure can be improved in some patients after surgery,and the reasons need to be further explored.In view of the adrenal dysfunction after aldosterone adenoma and nonfunctional adenoma,we believe that adrenal tumor resection is superior to total adrenal resection.