肾上腺囊性病变的诊断和外科治疗(附31例报告)

目的探讨肾上腺囊性病变的诊断和外科治疗方法，提高肾上腺囊性病变的诊治水平。方法回顾性分析31例肾上腺囊性变患者资料，经影像学检查，手术及病理证实非肿瘤源性患者21例，肿瘤源性患者10例。结果非肿瘤源性患者21例，其中单纯性囊肿15例，囊内出血感染或自发性出血所致的高密度囊肿6例。肿瘤源性患者10例，其中嗜铬细胞瘤9例，肾上腺神经节细胞瘤囊性变1例，8例嗜铬细胞瘤有激素活性症状。全部病例均行手术治疗，效果满意。结论B超、CT、MRI是诊断肾上腺囊性病变最可靠的定位诊断方法。强调在CT检查中有增强效应的囊性病变，要做内分泌功能检查。对直径〉4cm或有内分泌功能的肾上腺囊性病变应行外科治疗，〈4cm单纯性或单侧自发性出血性囊肿，无症状者可定期观察。

Diagnosis and surgical treatment for cystic disease of adrenal (report of 31 cases)

Objective To present our experience and to improve the diagnosis and surgical treatment of adrenal cystic disease. Methods The clinical data of 31 cases of adrenal cystic disease were reviewed. Based on the imaging, surgical and pathological evidence, 21 cases were non-tumorous cystic disease, 10 tumorous. Results In the cases of non-tumorous, no blood vessels were found by ultrasonic examination, no reinforcement by CT or MRI, and no abnormality by endocrinological test. In the 10 cases of tumorous eystic disease, 9 were pheochromocytoma, 8 of which had symptoms from hormone activity, and one was cystic degeneration of adrenal gangliocytoma. Operation was preformed in all this group with good results. Conclusion Ultrasound, CT and MRI are effective in diagnosis of adrenal cystic disease. Small, simple or unilateral spontaneously hemorrhagic cystic disease without symptoms can be treated conservatively with regular follow-up, while the others should be surgically treated. It suggests that hormonal evaluation should be performed in case the cyst wall shows enhancement in CT scan.