原発性アルドステロン症43例に関する臨床的検討 - 局在診断法と手術法の変遷 -

Abstract

過去26年間の本症手術症例43例について検討した.1)病因別にみると副腎皮質腺腫によるものが40例を占め, 男女比は1対3, 腫瘍の最大径平均1.88 cm, 重量平均2.67 gであった.2)局在診断法は副腎静脈造影法ならびに選択的静脈採血法(1972年), 副腎シンチ(1975年), CT (1979年), 超音波断層法(1980年)の順で施行されるようになり, 各々83%, 78%, 86%, 87%, 60%の術前診断率を示した.3)手術到達路は腰部斜切開による腹膜外式が32例, 経腹式11例と腹膜外式到達路が多く, 特に

Primary aldosteronism due to an adrenocortical adenoma is commonly known as surgically correctable hypertension. Forty-three cases of primary aldosteronism were treated operatively at our Department between 1960 and 1985. Forty of them were operatively, found to have aldosteronoma with a mean size of 1.88 cm and weight of 2.67 g. The patients average age was 39.4 years old and the male to female ratio was 1 to 3. Adrenal phlebography, selective adrenal venous sampling, adrenal scintigraphy, CT and echography were used to preoperatively locate the tumor, and their diagnostic value was 83, 78, 76, 87 and 60%, respectively. Unilateral adrenalectomy or unilateral partial adrenalectomy was performed extraperitoneally with lumbar oblique incision in 32 of the 43 operated patients. Since the application of the preoperative diagnosing studies above mentioned, tumor localization has been clearly demonstrated in about 90% of the patients and the unilateral extraperitoneal approach is proved as a safe operative method with minimal blood loss of less than 200 ml and performed within two hours. Unilateral adrenalectomy by the flank approach has now become the operation of choice for the treatment of an aldosterone-producing adrenal adenoma.