肾上腺偶发瘤的临床对策

The Clinical Strategy of Adrenal Incidentalomas

目的:探讨肾上腺偶发瘤的临床对策。方法:回顾总结2002年1月～2004年5月收治的50例肾上腺偶发瘤病例资料。结果:50例经腰切除31例,经腹切除10例,腹腔镜切除9例,效果满意。病理检查皮质腺瘤31例,皮质增生3例,皮质腺癌2例,嗜铬细胞瘤8例,肾上腺囊肿3例,髓质脂肪瘤1例,节细胞瘤1例,肾上腺转移癌1例。结论:所有肾上腺偶发瘤均应行内分泌功能检查,肾上腺B超、CT、MRI对确诊肾上腺占位病变有较高价值。除诊断明确的<3.0cm的肾上腺囊肿和肾上腺髓样脂肪瘤外均应早期手术治疗。腹腔镜手术创伤小,恢复快,为首选术式,肿瘤较大或与周围脏器有粘连者宜经腹手术。

Objective: To evaluate the favourable strategy for diagnosis and treatment of the adrenal incidentalomas. Methods: A total of 50 cases with adrenal incidentaloma, from 2002 to 2004, were analyzed. Results: Total resection was performed in all cases, of which 31 were treated by transabdominal operation, ten cases by translumbar operation and nine by laparoscopicsurgery. Of all types of the adrenal incidentalomas, 31 were adenomas, two adrenal carcinomas, eight heochromocytomas, three adrenal gland cysts, one myelolipoma, one ganglioneuroma and one adrenal metastatic carcinoma. Conclusion: Before operation, the routine endocrine examinations should be taken in all adrenal incidentalomas. The ultrasoun-B, CT scanning and MRI are of high value in ascertaining an adrenal tumor. Early surgical operation should to be performed except for the adrenal gland cyst and myelolipoma, which were less than 3.0 cm in size. The first option is laparoscopic surgery. The transabdominal operation should be undertaken for tumors with greater diameter and suspected malignancy.