667例肾上腺偶发瘤的临床分析

Clinical analysis of 667 adrenal incidentalomas

目的:分析肾上腺偶发瘤的临床特点,探讨其诊治经验。方法:回顾性分析2001年1月至2013年1月667例中山大学附属肿瘤医院和附属第一医院肾上腺肿瘤患者的临床资料。结果:667例患者中病理确诊的肾上腺偶发瘤为511例。最常见的病理类型为皮质腺瘤240例,占47%(240/511);嗜铬细胞瘤90例,占18%(90/511);皮质腺癌41例,占8%(41/511)。511例患者中肿瘤直径≤4 cm为266例,良性占98%(260/266),183例行腹腔镜下肾上腺肿瘤切除术;肿瘤直径>6 cm为245例,恶性占37%(91/245),162例行开放性肾上腺肿瘤切除术。结论:诊断肾上腺偶发瘤时肿瘤直径4 cm为参考临界值。腹腔镜肾上腺切除术是直径≤4 cm的肾上腺偶发瘤患者的首选治疗。

Objective：To investigate the clinical characteristics of adrenal incidentaloma and explore the management strategies for this disease.Methods：The clinical data of adrenal neoplasm patients admitted in The First Affiliated Hospital and Cancer Center of Sun Yat-sen University from January 2001 to January 2013 were analyzed retrospectively.Results：The data of 667 patients with adrenal incidentaloma were analyzed.Adenoma was the most common tumor in 511 cases with pathological results（240/511,47%）.Furthermore,the pathologic results indicated that 18%（90/511） of these cases were pheochromocytoma and 8%（41/511） were adrenocortical carcinoma.Of the 511 cases,266 had ≤4 cm tumors,and 245 had 6 cm tumors.In cases with ≤4 cm tumors,260（98%） had benign tumors,and 183 of these cases underwent laparoscopic adrenalectomy.In cases with 6 cm tumor,91 cases（37%） had malignant tumors,and 162 of these cases underwent open adrenalectomy.Conclusion：The suggested cut-off size for adrenal incidentaloma diagnosis is 4 cm.Laparoscopic adrenalectomy is the recommended management strategy for small（≤4 cm） and nonfunctional adrenal incidentaloma.