Endoscopic bilateral adrenalectomy in patients with ectopic Cushing's syndrome
Endoscopic bilateral adrenalectomy in patients with ectopic Cushing's syndrome
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DOI：
10.1007/s00464-011-2020-7
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发表时间：
2012-04-01
影响因子：
3.1
通讯作者：
Burger, Jacobus W. A.
中科院分区：
文献类型：
--
作者：
Alberda, Wijnand J.;van Eijck, Casper H. J.;Burger, Jacobus W. A.
背景：双侧肾上腺切除术(BLA)是缓解异位库欣综合征(ECS)患者症状的一种治疗方法，对于这些患者来说，非垂体肿瘤的外科治疗是不可能的。由于皮质醇水平高、临床条件差和代谢紊乱，ECS患者发生并发症的风险增加。本研究旨在评价内窥镜下BLA治疗ECS的安全性和远期疗效。方法1990年至今，在第三转诊中心伊拉斯谟大学医学中心对38例ECS患者进行诊断和治疗。24例行BLA治疗(21例行内窥镜下治疗，3例行开放手术治疗)，9例行内科治疗，5例经完全切除促肾上腺皮质激素(ACTH)肿瘤治愈。对医疗记录进行了回顾，并将其输入数据库。结果21例患者中，20例顺利完成内窥镜下全血置换，1例中转开放全血。术中并发症2例(10%)，术后并发症3例(14%)。中位住院时间9(2~95)d，中位手术时间246(205~347)min。所有患者的皮质醇增多症均得到缓解。87%、90%、65%、61%和78%的患者高血压、体重、库欣金外观、肌力受损和踝关节浮肿得到改善。糖尿病、低钾血症和代谢性碱中毒分别有33例、和80%得到缓解。结论BLA是治疗异位库欣综合征的一种安全有效的方法。
Background Bilateral adrenalectomy (BLA) is a treatment option to alleviate symptoms in patients with ectopic Cushing's syndrome (ECS) for whom surgical treatment of the responsible nonpituitary tumor is not possible. ECS patients have an increased risk for complications, because of high cortisol levels, poor clinical condition, and metabolic disturbances. This study aims to evaluate the safety and long-term efficacy of endoscopic BLA for ECS.Methods From 1990 to present, 38 patients were diagnosed and treated for ECS in the Erasmus University Medical Center, a tertiary referral center. Twenty-four patients were treated with BLA (21 endoscopic, 3 open), 9 patients were treated medically, and 5 patients could be cured by complete resection of the adrenocorticotropic hormone (ACTH)-producing tumor. The medical records were retrospectively reviewed and entered into a database. For evaluation of the efficacy of BLA, preoperative biochemical and physical symptoms were assessed and compared with postoperative data.Results Endoscopic BLA was successfully completed in 20 of the 21 patients; one required conversion to open BLA. Intraoperative complications occurred in two (10%) patients, and postoperative complications occurred in three (14%) patients. Median hospitalization was 9 (2-95) days, and median operating time was 246 (205-347) min. Hypercortisolism was resolved in all patients. Improvements of hypertension, body weight, Cushingoid appearance, impaired muscle strength, and ankle edema were achieved in 87, 90, 65, 61, and 78% of the patients, respectively. Resolution of diabetes, hypokalemia, and metabolic alkalosis was achieved in 33, 89, and 80%, respectively.Conclusion Endoscopic BLA is a safe and effective treatment for patients with ectopic Cushing's syndrome.