原发性醛固酮增多症微创治疗2例并文献复习

Two Cases and Literature Review of Minimally Invasive Treatment of Primary Aldosteronism

摘要: 原发性醛固酮增多症(PA)是由肾上腺皮质过度分泌醛固酮所致的一种临床综合征，其主要病因包括单侧肾上腺腺瘤、双侧肾上腺增生及单侧肾上腺增生等，而双侧肾上腺腺瘤较为少见。在临床诊疗中，常需借助肾上腺静脉采血(AVS)以明确醛固酮分泌的优势侧。本文报道2例确诊醛固酮瘤的PA患者，病例1肾上腺增强CT提示双侧肾上腺可疑结节，行AVS明确优势侧接受肾上腺动脉栓塞术治疗；病例2肾上腺CT提示左侧肾上腺腺瘤(可能)，接受腹腔镜手术治疗。结合相关文献，对比分析腹腔镜手术与血管介入在PA治疗中的疗效差异，以期为临床医师选择个体化治疗方案提供参考。

Abstract: Primary aldosteronism (PA) is a clinical syndrome caused by excessive aldosterone secretion from the adrenal cortex. Its main etiologies include unilateral adrenal adenoma, bilateral adrenal hyperplasia, and unilateral adrenal hyperplasia, while bilateral adrenal adenoma is relatively rare. In clinical diagnosis and treatment, adrenal venous sampling (AVS) is often used to identify the dominant side of aldosterone secretion. This article reports 2 PA patients diagnosed with an aldosterone-producing adenoma. In Case 1, enhanced adrenal CT showed suspicious bilateral adrenal nodules, and AVS was performed to confirm the dominant side before adrenal artery embolization was given. In Case 2, adrenal CT indicated a possible left adrenal adenoma, and the patient underwent laparoscopic surgery. Combined with relevant literature, this article compares and analyzes the efficacy differences between laparoscopic surgery and vascular interventional therapy in the treatment of PA, aiming to provide references for clinicians in selecting individualized treatment plans.