Еndoscopic surgery of the suprarenal glands tumors in primary hyperaldosteronism
Objective. To estimate the efficacy of surgical treatment of patients, suffering primary hyperaldosteronism (PHA).
Маterials and methods. In a 2014 - Feb. 2018 yrs period in the Clinic of Hospital Surgery of the Zaporizhzhya State Medical University in 46 patients a PHA was diagnosed, оperative treatment was conducted in 23 patients, among whom there were 15 (65%) women and 8 (35%) men. The average age have constituted (52.3 ± 9.5) yrs old. In accordance to the CT and MRT data a right-sided localization of the suprarenal glands adenomas was established in 10 (43.5%) patients, a left-sided - in 7 (30.4%), and a bilateral - in 6 (26.1%). The dimensions of the volume suprarenal glands tumors have constituted (18.3 ± 6.7) mm. The diagnosis was conducted in accordance to the Clinical Practice Guideline for The Management of Primary Aldosteronism; 2008, 2016). Оperative treatment was conducted, using endoscopic methods. Laparoscopic adrenalectomy was performed in 19 (82.6%) patients, and laparoscopic resection of a suprarenal gland - in 4 (17.4%). The results of operative treatment were estimated in accordance to standard and clinical-biochemical criteria PASO (Primary Aldosteronism Surgical Outcomes).
Results. The operation duration have constituted 150 (120 - 200) min at average, and duration of the patients’ stationary stay - (9 ± 2.1) days. There were no conversions, nor postoperative morbidity. Nobody of the patients died. Comparative analysis of the operative treatment results have shown a statistically trustworthy lowering of the systolic arterial pressure indices (САТ), diastolic arterial pressure (DAP), concentration of aldosterone and raising of the potassium level (p < 0.05). Correlation analysis did not reveal a statistically trustworthy connection between concentration of aldosterone and the left ventricle myocardial mass, the interventricle septum thickness, thickness of the left ventricle posterior wall in the patients before and after the operative treatment. Clinical results of surgical treatment of patients, suffering PHA, estimated in accordance to PASO criteria and the standard criteria, are practically similar: complete recovery was registered in 39.2 and 43.5% patients, and a partial one - in 60.8 and 56.5% patients, accordingly; biochemical results, estimated similarly, have been differed essentially: complete recovery - 91.3 and 43.5%, and a partial one - 8.7 and 56.5% accordingly.
Conclusion. In surgical treatment of the patients with the suprarenal glands adenomas, accompanied by PHA, it is mandatory to give advantage to laparoscopic methods (аdrenalectomy, resection). The efficacy of miniinvasive methods of surgical treatment of PHA is statistically trustworthy. Clinico-biochemical criteria PASO in estimation of the surgical treatment results in patients, suffering PHA, have advantage over the standard, because they are complex. After surgical treatment of the patients, suffering PHA, a complete biochemical recovery occurs in 91.3% patients, complete clinical one - in 39.2%, partial biochemical - in 8.7%, partial clinical - in 60.8%.
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