肾上腺囊性占位性病变的诊治分析

目的:提高肾上腺囊性病变的诊治水平。方法:回顾性分析38例肾上腺囊性病变患者的临床资料,经影像学、手术及病理检查证实,其中非肿瘤源性囊性病变30例,肿瘤源性囊性病变8例。结果:囊肿内出血、感染或自发性出血所致高密度囊肿24例,单纯性囊肿6例。前者均有不同程度的腰、背、腹部胀痛,其中3例伴有贫血,2例伴有肝功能异常;后者均无临床症状。B超检查肿物内无血管,CT、MRI增强扫描肿物无强化,内分泌检查正常。肿瘤源性囊性病变患者中,嗜铬细胞瘤5例,皮质腺瘤2例,节细胞神经瘤1例。5例有激素活性症状,内分泌检查部分有相应激素水平升高。B超、CT、MRI显示囊壁>0.3 cm,且厚薄不均,CT、MRI增强扫描后,囊壁可有强化,以嗜铬细胞瘤囊壁强化最为显著。手术治疗36例,除1例因车祸、1例因脑血管意外死亡外,34例效果满意。结论:B超、CT、MRI可帮助诊断肾上腺囊性病变。无论是非肿瘤源性肾上腺囊性病变,还是肿瘤源性肾上腺囊性病变,只要条件允许,均应手术治疗。

Analysis of diagnosis and treatment of cystic lesion of adrenal gland

Objective:To describe the improvement of diagnosis and treatment of adrenal cystic lesions.Methods:The clinical data of 38 cases of adrenal cystic lesion were reviewed.Based on the imaging,surgical and pathological evidence,30 cases had non-tumor originating cystic lesion,and 8 had tumor originating cystic lesion.Results:In the cases of non-tumor originating lesion,there are 6 cases of simple cystoma without symptom,and 24 cases of intracystic hemorrhage or infection with symptoms of pain in waist,back and abdomen,in which 3 cases had anemia and 2 had liver lesions.All the 30cases had no symptoms from hormone activity,no blood vessels found in the cystic lesion by ultrasonic examination,no reinforcement in the lesion by CT or MRI,and no abnormality by endocrinological test.In 5 cases of tumor originating lesion,there were symptoms from hormone activity,and elevated hormone level.Ultrasonic examination,CT and MRI showed thickened cyst wall,which reinforced by CT and MRI.Operations were performed in 36 cases with good results,except for 1 who died by traffic accident and 1 by cerebrovascular attack.Conclusions:Ultrasound,CT and MRI are effective in diagnosis of adrenal cystic lesion.Surgical treatment must be performed in both non-tumor and tumor originating lesions of adrenal gland as long as the conditions permit.