肾癌根治术中切除肾上腺的适应证

The adrenalectomized indicationsin radical nephrectomy for the treatment of renal cell carcinoma

目的:探讨行肾癌根治术时切除肾上腺的适应证。方法:对484例患者行肾癌根治术中,213例同时切除同侧肾上腺,2例切除对侧肾上腺,1例切除双侧肾上腺;270例保留同侧肾上腺。结果:216例切除肾上腺经病理检查,11例(5.1%)发现有肾上腺转移,4例肾上腺良性病变。11例转移病例中8例术前CT(MRI)提示有肾上腺转移,肾上腺转移患者的肿瘤直径均值>8cm;1例为T1期肿瘤,6例为T3期肿瘤,4例为T4期肿瘤。268例保留肾上腺组中,1例于术后14个月发现同侧肾上腺肿瘤转移,1例于术后28个月发现双侧肾上腺转移。结论:CT是肾癌术前诊断及术后随访的重要影像诊断方法;保留同侧肾上腺手术仅在肿瘤局限于肾内且直径≤4cm才是安全的;怀疑对侧肾上腺有肿块时,均应手术探查。孤立的肾上腺转移,是肾上腺转移瘤切除术的适应证。

Objective：To investigate the adrenalectomized indications in radical nephrectomy for the treatment of renal cell carcinoma. Methods：Of 484 patients treated for renal cancer between 2001 and 2005, 213 had renal surgery with concomitant ipsilateral adrenalectomy, 2 contralateral adrenalectomy and 1 bilaterally adrenalectomy. Results： Of 216 adrenal glands removed during renal surgery, metastases were noted in 11 （5.1%） cases on pathological examination, 4 had a benign pathology. Among the patients with adrenal metastases, the mean diameter of renal tumour were 〉8 cm, 1 case having T1, 6 having T3, 4 having T1 stage tumor by WHO 2002 staging system. Of 268 adrenal glands retained during renal surgery, 1 metachronous adrenal metastases was diagnosed at 14 months after renal surgery, 1 bilateral adrenal metastases was diagnosed at 28 months after renal surgery. Conclusions：Sparing the ipsilateral adrenal is advisable in patients with organ-confined renal tumours of 〈 4 cm in diameter. Isolated adrenal metastasis should be treated by metastasectomy, When contralateral adrenal glands had suspicious lump, surgical detection should be done during surgery. CT scan had good diagnostic ability for the adrenal gland, especially for contralateral adrenal gland and during the follow-up.