肾上腺肿瘤的诊断及微创治疗

Diagnosis and minimally invasive treatment of adrenal tumors

随着内分泌学检查和影像学的进步，肾上腺肿瘤的检出率增加，诊治标准逐步完善。诊断方面，高血压人群的影像学筛查指征、亚临床内分泌腺瘤的治疗策略、影像学检查对肿瘤性质的鉴别是下一步的研究热点。治疗方面，腹腔镜已成为肾上腺良性肿瘤治疗的“金标准”，而恶性肿瘤和嗜铬细胞瘤的微创治疗的适应证不断拓宽，主要体现于腹腔镜在体积6～10 cm的肾上腺皮质癌和体积＆gt;6 cm的嗜铬细胞瘤患者中应用。肾上腺部分切除的手术范围和适应证主要依靠医师临床经验。另外微创治疗围手术期的处理亦应得到充分重视。本文针对以上内容做一综述。

Minimally invasive approach has been the gold standard therapy for adrenal tumor since 1992. The improvements of endo-crine test and radiographic options that are used to evaluate adrenal lesion relevance ratio have promoted the diagnosis and treat-ment. Future research may focus on secondary hypertension screening, subclinical situation of functional adrenal tumor, and differen-tial diagnosis through imaging tests and other methods. Subclinical hypercortisolism and the relationship between incidentaloma and metabolism should be given particular importance. Laparoscopic adrenalectomy has become the gold standard approach for adrenal benign tumor treatment. The indication for usage of this approach has extended and included adrenal carcinoma （tumor size ranging within 6-10 cm） and pheochromocytoma larger than 6 cm. Partial adrenalectomy mainly depends on surgeon＆#39;s experience. In addi-tion, the perioperative period of minimally invasive surgery need further research. This paper reviews related studies.