肾上腺囊肿15例诊治分析

Diagnosis and treatment of adrenal cyst： report of 15 cases

目的探讨肾上腺囊肿的诊断与治疗。方法对1995-2005年我院收治的15例肾上腺囊肿患者进行回顾性分析，本组男9例，女6例；平均年龄42岁，2例患者因腰背酸胀不适检查发现，4例因上腹胀满不适等其他症状就诊，9例患者体检发现囊肿。囊肿位于左侧9例，右侧6例；囊肿直径2．5—8．5cm，平均为5．3cm。B超检查正确率为73．3％（11／15）；CT检查正确率为86．7％（13／15）；MR检查4例，皆诊断为。肾上腺囊肿。13例患者接受手术治疗，9例行后腹腔镜囊肿去顶减压或切除术，1例行经由腹腔腹腔镜肾上腺切除术，3例行开放手术囊肿切除术。结果腹腔镜组平均手术时间（44±11）min；开放手术组手术时间平均手术时间（75±40）min，开放组手术时间明显长于腹腔镜组（P〈0．05）。术后患者均恢复良好，腹腔镜组患者平均住院时间（5．1±1．1）d；开放手术组患者平均住院时间（8．3±1．5）d，腹腔镜组患者住院时间明显短于开放手术组（P〈0．05）。病理报告提示内皮性囊肿4例，假性囊肿6例，上皮性囊肿3例。结论MR是检查肾上腺囊肿最有效的方法。囊肿直径较大，明显压迫临近器官，伴有局部症状；假性囊肿，怀疑恶性病变以及伴有内分泌异常等均可选择手术治疗。腹腔镜肾上腺囊肿去顶减压或切除术是治疗肾上腺囊肿的有效方法，在怀疑有恶性可能时可考虑行开放手术。

Objective To discuss the diagnosis and treatment of adrenal cyst. Methods The clinical data of 15 patients with adrenal cyst, 9 males and 6 females, aged 42 （32-65）, diagnosed and treated 1995-2005 were reviewed. The average size of the cyst was 5.3 cm in diameter. Nine cysts were in the left adrenal gland and 6 cysts in the fight. The diagnostic accuracy rates of MR imaging, CT, and B- mode ultrasonography were 100% （4/4）, 86.7% （ 13/15 ）, and 73.3% （ 11/15 ） respectively. Thirteen patients underwent operation ： unroofing in cyst via retroperitoneal laparoscopy （ n = 9 ） , adrenalectomy via laparoscopy （ n = 1 ） , or cystectomy via open surgery （ n = 3 ）. Results The average operative time of the 2 laparoscopy subgroups was （44 ± 11 ） rain, significantly shorter than that of the open surgery group [ （75 ± 40） rain, P 〈0. 05]. The mean hospital stay after operation of the laparoscopy group was （5. 1 ± 1. 1 ） days, significantly shorter than that of the open surgery group [ （ 8.3 ± 1.5 ） days, P 〈 0.05 ]. Pathological examination showed 3 cases of epithelial cyst, 4 cases of endothelial cyst, and 6 cases of pseudocyst. Conclusion MR is much more useful in diagnosis of adrenal cyst. The indications of surgery include the presence of symptoms, suspicion of malignancy, increase in the cyst size, and detection of functioning adrenal cyst. Unroofing in cyst via retropefitoneal laparoscopy may be the standard operation in treating this disease.