86例肾上腺偶发瘤临床分析

The Clinical Analysis of 86 Cases with Adrenal Incidentoloma

目的 提高肾上腺偶发瘤（AI）的诊断与鉴别诊断水平,指导临床治疗。方法 回顾性分析我院2005年1月至2011年12月因健康体检或肾上腺疾病以外原因就诊发现的86例肾上腺偶发瘤患者的临床资料,并复习国内外相关文献。结果 86例AI患者中84例（97.7%）接受手术治疗,后腹腔镜手术55例（64.0%）,其中4例中转开放手术,有内分泌功能肿瘤37例（43.0%）,术后病检确诊皮质腺瘤40例,嗜铬细胞瘤24例,髓性脂肪瘤8例,囊肿5例,皮质腺癌2例,肾上腺皮质结节样增生2例,转移性肿瘤1例,血管平滑肌脂肪瘤1例,神经节细胞瘤1例。81例良性肿瘤随访1-6年未见复发,3例转移性肿瘤均在2年内死于原发肿瘤,2例皮质腺癌中1例术后11个月死于广泛转移,1例随访2年3个月仍存活。结论 影像学检查结合内分泌检测有助于AI的定位及定性诊断,明确诊断的〈3cm的肾上腺囊肿、血肿及髓性脂肪瘤可随访观察除外,其余AI均应积极手术,腹腔镜手术是AI的首选术式。

Objective To improve diagnosis and differential diagnosis of adrenal incidentoloma to guide clinical therapy. Methods The clinical data of 86 cases of adrenal incidentoloma from January of 2005 to December of 2011 were retrospectively analysed,relative papers were also reviewed. Results 84 cases received operation,55 cases received retmperitoneal laparoscopic surgery,37 cases were tumors with secretary function,post operative pathology finally diagnosed adrenalcortical adenoma in 40 cases,pheochromocytoma in 24 cases,myelolipoma in 8cases,cyst in 5 cases,adrenalcortical carcinoma and adrenal nodular hyperplasia in 2 cases,metastatic tumor,angioleiomyolipoma and paragangliloma in 1 case. All benign tumors were followed up 1-6 years without recurrence,metastatic tumors died in 2 years,one of adrenalcortical carcinoma died 11 months after operation,the other still survived 2 years and 3 months after operation. Conclusion Imaging examinations and laboratory tests are beneficial to diagnosis, AI cases should receive surgery positively except cyst,myelolipoma and hematoma less than 3cm in diameter, laparoscopic surgery can be first choice of operation.