肾上腺偶发瘤临床诊治策略

Clinical diagnostic and therapeutic strategies of adrenal incidentaloma

目的探讨肾上腺偶发瘤的临床诊治策略。方法回顾性分析172例肾上腺偶发瘤患者的临床资料,并对手术病例病理结果进行分析。结果 166例行腹腔镜手术治疗,经后腹腔镜97例,其中中转改开放手术5例;经腹腹腔镜69例,无中转开放。切除的肿瘤直径平均(5.3±2.9)cm(1.5~8.7 cm)。术后病理诊断为良性肾上腺偶发瘤160例(96.4%),其中肾上腺皮质腺瘤114例,肾上腺髓性脂肪瘤3例,原发性醛固酮增多症11例,亚临床库兴综合征12例,嗜铬细胞瘤14例,肾上腺囊肿6例。恶性肿瘤6例(3.6%),其中肾上腺皮质腺癌4例。结论 CT或MRI结合内分泌功能检测对鉴别肾上腺偶发瘤良恶性以及评估其功能状态具有较高价值。直径<4 cm的良性或无功能性肿瘤可随访观察。功能性肿瘤、直径≥4 cm可疑恶性肿瘤和随访过程中肿瘤增大者应采取手术治疗。

Objective To evaluate effective diagnostic and therapeutic strategies of adrenal incidentaloma. Methods A retrospective study was performed to analyze the clinical data for 172 cases with adrenal incidentaloma. Pathologic diagnoses were analyzed in surgical cases. Results Laparoscopic adrenalectomy was performed in a total of 166 cases,of which 97 underwent retroperitoneal approach with conversion to open surgery in 5 cases and 69 underwent transperitoneal approach without conversion to open surgery. The mean tumor diameter was( 5. 3±2. 9) cm( range: 1. 5 ~ 8. 7 cm). Pathologic examination revealed 160 benign tumors( 96. 4%),including 114 adrenaocortical adenomas,3 adrenal myelolipomas,11 primary aldosteronomas,12 subclinical Cushing's syndrome,14 pheochromocytomas and 6 adrenal cysts. 6( 3. 6%) malignant tumors were identified,including adrenocortical carcinoma in 4 cases. Conclusions Radiological( CT and/or MRI) and endocrine assessment are the keys tool to distinguish malignant from benign lesions and evaluate hormonal activity. Benign or non-hypersecreting hormone lesion with <4 cm diameter could be sent to follow-up. Hypersecreting adrenal tumors or ≥4 cm diameter tumors with underlying malignancy or growth during follow-up could be treated with surgical adrenalectomy.