肾上腺囊肿155例临床分析

Clinical analysis of 155 adrenal cyst cases

目的探讨肾上腺囊肿的诊断和治疗方法及腹腔镜微创治疗肾上腺囊肿的安全性和有效性。方法回顾性分析1990年1月～2011年7月北京协和医院收治的155例肾上腺囊肿患者的临床资料。分析患者的临床资料、诊断过程、手术过程、相关的并发症、术后病理和随访结果。结果男性62例,女性93例。中位年龄43岁。位于单侧肾上腺154例,双侧肾上腺1例。囊肿直径2～11 cm,平均2.6 cm。术前诊断肾上腺囊肿准确性CT为92.2%,MRI为86.4%,B超为61.0%。术前内分泌检查除2例支持醛固酮腺瘤,2例支持嗜铬细胞瘤外,其余均提示无功能。腹腔镜手术146例,平均手术时间55 min,术后平均住院日2.2 d;开放手术9例,平均手术时间153 min,术后平均住院日8.6 d。围术期均无严重并发症出现。术后病理类型包括单纯性囊肿(86/156)、假性囊肿(67/156)、上皮性囊肿(3/156)。术后随访1～16年无1例复发。结论肾上腺囊肿诊断主要依靠影像学检查,增强CT是诊断肾上腺囊肿的有效方法,内分泌检查是必要的。对于功能性囊肿以及直径大于5cm、影像学检查提示存在实性成分的囊肿均建议手术治疗。腹腔镜手术可作为肾上腺囊肿首选的手术治疗方式。

Objective To optimize the diagnosis and treatment for adrenal cysts, and to evaluate the safety and efficacy of laparoscopic surgery for adrenal cysts. Methods One hundred and fifty-five patients with adrenal cysts underwent surgery in Peking Union Medical College Hospital. The preoperative symptoms, preoperative diagnosi treatments, intra- and postoperative complications, subclassification of adrenal cysts by Histology, and follow-up in patients after surgery were reviewed respectively. Results We identified 155 patients who underwent surgery for adrenal cysts. The median age was 43 years. 154 adrenal cysts were unilateral, and 1 case was bilateral. The diameter was 2. 6 cm on average, ranging from 2 to llcm. The accuracy of diagnosis of CT, MRI, and B-us was 92. 2%, 86. 4%, 61.0% respectively. By endocrinology test, 2 cases were diagnosed as primary aldosteronism, 2 cases as pheochromo- cytoma. 146 laparoscopic operations were performed, and 9 open operations were performed. The time of operation for laparoscopy and open procedure was 55 min and 153 min on average respectively, while the hospital stays after operation was 2. 2 days and 8. 6 days respectively. No severe perioperative complications occurred. Subclassification of adrenal cysts by histology included endothelial cysts（86/156）, pseudocysts（67/156）, and epithelial cysts（3/156）. At follow-up, no patient suffered recurrence. Conclusions Diagnosis of adrenal cysts predominantly depends on ima- ging, especially enhanced CT. Preoperative endocrinology test is necessary. Surgery is recommended for large cysts greater than 5 cm, cystic endocrine active adrenal tumors and cysts with chances of malignancy by imaging. Laparoscopic surgery is preferred as the first option for the surgical treatment of adrenal cysts.