肾上腺手术在治疗皮质醇增多症中的疗效评价(附90例报告)

Adrenal gland surgery in the treatment of hyperadrenocorticism curative effect appraisal

目的:提高皮质醇增多症的治疗水平。方法:总结90例皮质醇增多症的临床资料以及随访情况。90例患者均有库欣综合征的临床表现,内分泌检查提示高皮质醇状态。71例患者影像学检查发现肾上腺肿块,其中左侧32例,右侧34例;双侧肾上腺肿块5例。19例患者显示双侧肾上腺结节样增生。结果:90例患者均行肾上腺手术,其中60例行肾上腺肿块切除加同侧肾上腺部分切除;6例行肾上腺肿块切除加同侧肾上腺全切除;4例行同时行双侧肾上腺全切除术,6例行先后双侧肾上腺全切除术;11例行单侧肾上腺全切除术;3例行先后双侧肾上腺次全切除。病理显示6例原发性色素性皮质结节状肾上腺皮质增生(PPNAD);5例大结节样肾上腺皮质增生(AIMAH);57例肾上腺皮质腺瘤;5例肾上腺皮质癌;17例肾上腺皮质结节样增生,其中7例考虑异位ACTH综合征所致。结论:肾上腺皮质腺瘤切除术效果最好,库欣症状改善最显著。迁延难愈的库欣病,单侧肾上腺全切除,在短期内能缓解代谢症状。分时分侧行肾上腺全切除术,对治疗AIMAH和PPNAD更安全、稳定;根据异位ACTH综合征患者症状和病程,可同时行双侧肾上腺全切除或单侧肾上腺全切除。

Objective：To elevate the treatment of hyperadrenocorticism. Methods：90 cases of hyperadrenocorticism were reviewed and summarized retrospectively including the manifestations and the follow-ups. All patients have the clinical cushing syndrome. The endocrine examinations showed the high cortisol condition. 71 cases of imaging study were discovered adrenal gland tumour, Left side in which 32 examples, Right flank 34 examples; Two-sided adrenal gland tumour were 5 examples. 19 cases demonstrated the bilateral adrenal gland tubercle type proliferation. Results： All patients were undergone adrenal gland surgery. In which 60 cases were adrenal gland tumour excision adds with subtotal adrenalectomy; 6 cases of adrenal gland tumour excision adds with the unilateral adrenalectomy; 4 cases of bilateral adrenalectomy at the same time, 6 cases of successively bilateral adrenalecto my;ll cases were undergone unilateral adrenalectomy and 3 cases of bilateral subtotal excisions. The pathology demonstrated 5 cases primary pigmented nodular adrenocortical diseases （PPNAD）, 5 cases of adrenocorticotropin-independent macronodular adrenal hyperplasia（AIMAH）, 57 cases of adrenal cortex adenoma, 5 cases of adre nal cortex cancer,17 cases nodular adrenal hyperplasia in which 7 cases were caused by ACTH. Conclusions： The adrenal cortex adenoma surgery effect is the best, The Cushing symptom improvement is the most remarkable. Unilateraladrenalectomy is useful in short-term internal energy alleviation metabolism symptom for the difficult cushing diseases. To treat AIMAH and PPNAD with the successive minute lateral total adrenalectomy is safer and stable. Bilateral adrenalectomy can be done at same time or unilateral adrenalectomy depending on the course of disease of ACTH and the symptoms.