Laparoscopic simultaneous bilateral adrenalectomy for patients with bilateral aldosterone-producing (micro)adenoma: Assessment of feasibility and potential indication

我们评估了单侧/双侧醛固酮腺瘤患者行腹腔镜肾上腺切除术(LA)的可行性和结果。所有原发性醛固酮增多症(PA)患者均行肾上腺静脉采血，确定为高分泌侧(S)。(1)174例单侧PA患者行单侧全LA。所有手术均安全完成。其中近四分之一是产生醛固酮的微腺瘤。术后血浆醛固酮浓度和降压药物显著降低(p&lt；0.01，p&lt；0.05)。89.1%的患者高血压得到治愈或改善。(2)45例双侧肾上腺疾病患者(包括29例双侧肾上腺疾病患者)同时行双侧LA。所有手术均安全完成，无肾上腺功能不全。接受保留肾上腺的双侧LA的患者需要糖皮质激素替代；然而，所有患者都在24个月内停用。单侧或双侧LA均安全完成。对于单侧或双侧PA的患者，这些手术可获得满意的手术和内分泌结果。

We evaluated the feasibility and outcomes of laparoscopic adrenalectomy (LA) for patients with unilateral/bilateral aldosterone-producing adenomas. All patients with primary aldosteronism (PA) were conducted adrenal venous sampling and were decided hyper-secreting side(s). (1)A total of 174 cases with unilateral PA received unilateral total LA. All procedures were safely performed. Nearly one fourth of them were aldosterone-producing microadenoma. Plasma aldosterone concentration and anti-hypertensive drugs were significantly decreased after surgery (p<0.01, p<0.05). Hypertension was cured/improved in 89.1% of patients. (2) A total of 45 patients with bilateral adrenal disease (including 29 cases of bilateral PA) were performed simultaneous bilateral LA. All procedures were also safely accomplished without adrenal insufficiency. Patients undergoing adrenal-sparing bilateral LA required glucocorticoid replacement; however, all discontinued within 24 months. Either unilateral or bilateral LA was safely performed. These procedures for patients with unilateral/bilateral PA couldbring about satisfied surgical and endocrinological outcomes.