肾上腺皮质癌的诊断和治疗

Diagnosis and management of adrenocortical carcinoma

目的探讨肾上腺皮质癌的临床特点和治疗方法,提高肾上腺皮质癌的诊断和治疗水平。方法回顾性分析15例原发性肾上腺皮质癌(Adrenocorti calcarcinoma,ACC),其中有功能性肿瘤6例,无功能性肿瘤9例。15例ACC均行B超检查,11例诊断为ACC;11例行CT检查,9例诊断为ACC;4例行MRI检查,1例发现左肾静脉瘤栓。肿瘤最大径为3~20cm。按Sullivan分期:Ⅰ期2例、Ⅱ期3例、Ⅲ期4例、Ⅳ期6例。结果15例原发性ACC中2例未手术者分别于确诊后3个月、8个月死亡。行手术治疗者13例,术后1年内死亡3例,分别于术后1个月、2个月、6个月死亡。术后1年以上5年以内死亡2例,分别于术后17个月、18个月死亡,期间1例随访存活2年后失访,术后5年以上死亡2例。随访至2006年4月仍存活5例,存活时间8个月~12年8个月,平均存活5年。结论早期诊断和治疗ACC是改善预后的关键,根治性手术是有效的治疗方法。

Objective To study the clinical presentation and management of adrenocortical carcinomas and improve the diagnosis and management level of adrenocortical carcinomas. Methods Retrospectively analyzed 15 cases of primary adrenocortical carcinomas. 6 cases were functional tumors, and 9 cases were nonfunctional tu- mors. All primary ACC underwent B-US examination,11 cases were diagnosed as ACC. 11 cases underwent CT examination, 9 cases were diagnosed as ACC, 4 cases underwent MRI examination, tumor embolus was found in the left renal vein in 1 case.The maximal diameter of the tumors ranged from 3cm to 20cm, with an average di- ameter of 8cm. There were 2 cases of Sullivan stage Ⅰ, 3 cases of stage Ⅱ, 4 cases of stage Ⅲ, 6 cases of stage Ⅳ. Results In 15 cases of primary ACC, 2 cases without operation died in 3 months and 8 months after diagnosis. 13 cases underwent surgical management. 3 cases died within 1 year:1 month, 2 months and 6 months after operation. 2 cases died within 1~5 years: 17 months and 18 months after operation, 1 case lost follow up after 2 years’ survival. 2 cases died over 5 years after operation. 5 cases were still alive in 2006 april, who have survived for 8 months -12 years and 8 months, the mean survival duration was 5 years. Conclusion Diagnosis and management at early stage is critical for better prognosis of ACC. Complete surgical resection is effective.