中文摘要：

目的探讨单侧肾上腺切除术治疗肾上腺大结节增生的长期疗效。方法回顾性分析1983年1月至2015年12月收治的82例行单侧肾上腺全切术治疗的肾上腺大结节增生患者的临床资料，男49例，女33例。年龄17～73岁，平均50岁。有典型库欣综合征临床表现者41例，伴高血压74例、糖尿病38例、骨质疏松35例、骨折11例、水肿39例。促肾上腺皮质激素〈2．2pmol／L者占78．5％（62／79）；79例行24h尿游离皮质醇测定，〉284．2nmol／L者67例；63例行小剂量地塞米松抑制试验，不被抑制者61例；53例行大剂量地塞米松抑制试验，不被抑制者47例。cT或MRI均显示双侧肾上腺不规则结节。对82例影像学检查显示肾上腺增生明显的一侧行肾上腺切除术，其中行右侧肾上腺切除术47例，左侧肾上腺切除术35例；77例行腹膜后腹腔镜手术，5例行开放手术。结果所有切除标本病理诊断均为肾上腺大结节增生。术后80例获随访，随访时间3～156个月，平均48．5个月，2例失访。短期内（≤6个月）58．5％（24／41）的患者库欣综合征症状消失，56．3％（45／80）的患者体重下降，63．5％（47／74）的高血压患者血压下降，76．3％（29／38）的糖尿病患者空腹血糖下降，全部水肿患者[100％（39／39）]水肿均消失。76例获得长期随访（〉6个月），63例（82．9％）患者术后1—60个月（平均14．6个月）症状复发伴24h尿游离皮质醇升高，其中29例（46．0％）接受对侧肾上腺全切或次全切除术。复发者中，90．5％（57／63）的患者以难以控制的高血压为首发的复发症状。2例分别于术后2年和7年因心血管意外和肺部感染死亡。结论对于肾上腺大结节增生，单侧肾上腺切除术具有短期效果，但长期疗效不佳，多数患者症状复发，并需要行对侧肾上腺的手术治疗。

英文摘要：

Objective To assess the long-term outcome of unilateral adrenaletomy in patients with adrenocorticotropic hormone independent macronodular adrenal hyperplasia （AIMAH）. Methods The data from 82 cases of AIMAH were reviewed and summarized including clinical manifestations, endocrinological data, imaging findings and postoperative follow-up. Fouty-nine males and thirty-three females with a mean age of fifty years composed our series. Among the 82 cases, 41 demonstrated Cushing syndrome（CS） , 74 presented with hypertension, 38 manifested diabetes mellitus, 35 complicated of osteoporosis and 11 of them with bone fracture, 39 complained of edema. Laboratory tests showed low ACTH plasma levels （ 〈 2. 2 pmol/L） in 62 of 79 cases. High level of 24-hour urinay free cortisol excretion（ 〉 284. 2nmol/L） was found in 67 of 79 cases. Elevated serum cortisol with loss of the circadian rhythm was presented in 55 of 60 cases. Failed to suppress cortisol secretion was observed in 61 of 63 conducted with low-dose dexamethasone suppression tests and in 47 of 53 implemented with high-dose dexamethasone suppression tests. Bilateral massively enlarged muhinodular adrenal glands were found in all cases with CT or MR imaging. Unilateral adrenalectomy was performed in the larger side of adrenal gland in all 82 cases. All adrenalectomies were carried out including 47 in right sides and 35 in left sides, with 77 by retroperitoneoscopic approach and 5 by open retroperitoneal approach. Results Histopathological examination confirmed nodular hyperplasia of the adrenal cortex for all specimens. After a mean duration of 48. 5 months, 80 of 82 patients were available for follow-up. Most clinical symptoms resolved within 6 months after operation. Cushingoid features disappeared in 58. 5% （24/41）of patients who initially presented with typical signs of Cushing Syndrome. Weight loss was seen in 56. 3% （45/80）. Improvement of hypertension and diabetes was observed in 63.5% （47/74） and 76. 3% （29/38） respectively. Al