肾上腺偶发瘤的诊治分析

Analysis of the diagnosis and treatment of adrenal incidentalomas

目的:提高肾上腺偶发瘤的诊断和治疗水平。方法:回顾性分析1998年1月～2006年7月收治的48例肾上腺偶发瘤患者的临床资料,并进行术后病理及随访结果分析。46例患者行手术治疗,其中开放手术15例,经腹腔镜治疗31例。结果:手术效果满意。术后病理检查诊断为肾上腺皮质腺瘤27例,肾上腺囊肿5例,肾上腺皮质癌2例,肾上腺髓性脂肪瘤3例,肾上腺嗜铬细胞瘤3例,原发性醛固酮瘤3例,腹膜后原发性淋巴瘤、皮质腺瘤伴灶状髓性脂肪瘤、转移癌各1例。影像学及实验室检查术前获正确诊断者32例(66.7%)。结论:所有肾上腺偶发瘤均应行内分泌功能检查。内分泌功能检查与CT或MRI联合应用对确诊肾上腺占位性病变有较高价值。对于确诊为恶性肿瘤、功能性肿瘤、转移性肿瘤及直径大于3cm的肿瘤,应积极采取手术治疗。腹腔镜手术创伤小,恢复快,为首选术式。对非功能性、直径小于3.0cm的肿瘤,可定期行生化和影像学检查。

Objective： To improve the levels of diagnosis and treatment for adrenal incidentalomas. Methods： The clinical data of 48 patients with adrenal incidentalomas diagnosed and treated from 1998 to 2006, were retrospectively analyzed. Results： Total satisfactory resection was performed in 46 cases, of which 31 were treated by laparoscopic surgery, 7 cases by trans-abdominal operation and 8 cases by translumbar operation. Postoperative pathology confirmed adrenal cortical adenoma in 27 cases, adrenal cyst in 5 , adrenocortical carcinoma in 2, adrenal myelolipoma in 3, adrenal pheochromocytoma in 3,primary aldosteronoma in 3, retroperitoneal primary lymphoma in 1, adrenocortical adenoma accompanied focal myelolipoma in 1 and adrenal metastatic carcinoma in 1. Diagnosis based on the results of imaging examinations and laboratory tests were correct in 32 cases（66.7%）. Conclusions： Before operation,the routine endocrine examinations should be taken in all adrenal incidentalomas, which combines with CT scanning and MRI are of high value in ascertaining an adrenal tumor. Early surgical operation should be performed for the final diagnosis of malignant tumor,functional tumor,metastatic tumor and adrenal masses which are larger than 3.0 cm in size. Laparoscopic surgery is the optimum option. Nonfunctional tumor and masses which are small-er than 3.0 cm might be followed up by biochemical detection and image examination.