肾上腺恶性肿瘤的诊治(附34例报告)

Diagnose and Therapy of Malignant Adrenal Tumors

目的:探讨肾上腺恶性肿瘤的诊断和治疗方法。方法:回顾性分析34例肾上腺恶性肿瘤的临床资料。其中肾上腺皮质癌13例;恶性嗜铬细胞瘤8例;肾上腺转移癌8例;皮质癌并发同侧肾盂癌1例;节神经母细胞瘤1例;恶性纤维组织瘤1例;脂肪肉瘤1例;肾上腺髓外浆细胞瘤1例。全部34例患者中,有临床症状者23例,有内分泌功能改变者22例。结果:所有患者均接受手术治疗,其中29例肿瘤全切,4例肿瘤小部分或包膜残留,1例仅探查取活检。32例获得随访,时间为2个月～5年。死亡11例,死亡患者生存期为5～29个月,平均21个月。结论:对于肾上腺恶性肿瘤患者,手术切除是首选治疗方法,并且术后的随访很重要。肾上腺皮质癌患者总体预后较差,化疗和放疗可作为术后辅助治疗。恶性嗜铬细胞瘤患者预后较好,MIBG和酚苄明可改善患者生存。对于转移性肾上腺肿瘤患者,手术切除孤立的转移灶可明显提高患者的5年生存率。

Objective：To discuss the diagnosis and therapy of malignant adrenal tumors. Methods：We analyzed the clinical datas of 34 cases with malignant adrenal tumors. 13 cases of adrenal cortical carcinoma, 8 cases of malignant pheochromocytoma, 8 cases of adrenal metastasis carcinoma, 1 case 0f adrenal cortical carcinoma accompany with renal pelvic carcinoma, and 1 case of ganglioneuroblastoma. 1 case of malignant fibrous histiocytoma, 1 case of liposaeoma and 1 case of adrenal extramedullary plasmacytoma. In all cases, 23 cases had clinical symp- toms; and endocrine abnormal occurred in 22 cases. Results：All patients accepted operations, complete resection of the mass in 29 cases, part resction of the tumor in 4 cases , 1 case only had a biopsy. 32 cases have the follow up from 2 months to 5 years. 11 cases died. The survival times were from 5 to 29 months, and mean time is 21 months. Conclusions：Surgical operation is the best way for patients wirh adrenal malignant tumor, and the follow-up is very important. The prognosis of adrenal cortical carcinoma is poor, chemotherapy and radiotherapy could be assisted and useful. The prognosis of malignant pheochromoeytoma is better, MIBG and dibenzyline could progress the survival. To the adrenal metastasis, surgery required for patients with isolated adrenal metastasis is necessary and could increases the 5 years survival.