关于"肾上腺偶发瘤52例临床分析"一文的几点意见

阅读第26卷第7期“肾上腺偶发瘤52例临床分析”一文，很有帮助。感谢作者总结了52例临床诊断和治疗的经验，但有2点值得商榷。     

肾上腺偶发瘤39例

目的：提高对肾上腺偶发瘤的诊治水平。方法：对肾上腺偶发瘤３９例进行术后病理及随访结果分析。结果：３７例经手术治疗,效果满意：１例恶性肿瘤并有肺转移者无法切除,仅取活检：１例肿瘤直径２．０ｃｍ,本人及家属不愿手术而出院随诊。结论：在健康体检时应常规行肾上腺Ｂ超检查,ＣＴ,ＭＲＩ对确诊肾上腺占位病变有较高价值。恶性肿瘤、功能性肿瘤直径≥２．０ｃｍ者均应手术,〈２．０ｃｍ者可行Ｂ超、ＣＴ随诊。     

肾上腺偶发瘤66例报告

目的 探讨肾上腺偶发瘤的临床特征和诊治措施.方法 回顾性分析66例肾上腺偶发瘤的临床资料.结果 定位诊断准确率:B超84.3%,CT 100%,MRI 100%;定性诊断准确率:B超30.0%,CT 75.5%,MRI 79.2%;手术60例:皮质腺瘤32例,肾上腺囊肿6例,髓性脂肪瘤5例,嗜铬细胞瘤5例,肾上腺转移性癌3例,皮质癌3例,神经节瘤3例,神经鞘瘤 1例,血肿1例, 肾上腺皮质结节增生1例.结论 肾上腺肿瘤筛查首选B超、CT、MRI,定位诊断准确;定性诊断应综合肿瘤大小、影像学特征、患者年龄及内分泌功能测定.疑诊嗜铬细胞瘤或定性诊断不明需手术时,应按嗜铬细胞瘤行术前准备.     

肾上腺偶发瘤的诊治

目的探讨肾上腺偶发瘤的诊断步骤和治疗方法的选择。方珐回顾性分析手术证实的129例肾上腺偶发瘤的临床资料。结果129例中125例完整切除肿瘤，肿瘤直径1．2—18cm。嗜铬细胞瘤31例，皮质腺瘤37例，皮质癌9例，转移癌4例，淋巴瘤3例，其他良性肿瘤45例。结论肾上腺偶发瘤中大部分为皮质和髓质肿瘤，因此需在术前做内分泌检查，确定有无功能；对直径大于3cm的无功能肿瘤及有功能或疑有恶变的需手术治疗；而小于3cm无功能肿瘤可定期随访。     

肾上腺偶发瘤的诊治分析

目的：提高肾上腺偶发瘤的诊断和治疗水平。方法：回顾性分析1998年1月～2006年7月收治的48例肾上腺偶发瘤患者的临床资料,并进行术后病理及随访结果分析。46例患者行手术治疗,其中开放手术15例,经腹腔镜治疗31例。结果：手术效果满意。术后病理检查诊断为肾上腺皮质腺瘤27例,肾上腺囊肿5例,肾上腺皮质癌2例,肾上腺髓性脂肪瘤3例,肾上腺嗜铬细胞瘤3例,原发性醛固酮瘤3例,腹膜后原发性淋巴瘤、皮质腺瘤伴灶状髓性脂肪瘤、转移癌各1例。影像学及实验室检查术前获正确诊断者32例（66．7％）。结论：所有肾上腺偶发瘤均应行内分泌功能检查。内分泌功能检查与CT或MRI联合应用对确诊肾上腺占位性病变有较高价值。对于确诊为恶性肿瘤、功能性肿瘤、转移性肿瘤及直径大于3cm的肿瘤,应积极采取手术治疗。腹腔镜手术创伤小,恢复快,为首选术式。对非功能性、直径小于3．0cm的肿瘤,可定期行生化和影像学检查。     

肾上腺偶发瘤的现代处理

肾上腺偶发瘤目前已成为临床工作中比较常见的现象。如何处理这类无明显临床症状的肿物，是否需要手术治疗或何时手术，都是临床医生较为关注的问题。本文综述了国外近期有关肾上腺偶发瘤的发生概况，内分泌学状态，良性与恶性的鉴别与处理等方面的文献。     

肾上腺偶发瘤治疗的临床研究

目的 探讨肾上腺偶发瘤治疗方法.方法 回顾性分析1996年1月至2006年1月156例肾上腺偶发瘤患者的临床资料及随访结果.结果 156例患者中1例因多器官转移行放疗、化疗,4例肿瘤较小者随诊观察,151例接受手术治疗.肿瘤直径1.3～15.0 cm.病理结果提示嗜铬细胞瘤34例,皮质腺瘤83例,皮质癌5例,转移癌3例,肾上腺囊肿等其他良性肿瘤26例.随访136例,随访时间1～7年,3例转移癌患者1.5年内均死亡;随访到的2例皮质癌患者分别于术后2.0、2.5年死于复发、转移.余131例均健康存活,其中3例口服地塞米松至术后1年.结论 恶性肿瘤、有功能肿瘤、亚临床型肾上腺皮质肿瘤、嗜铬细胞瘤、直径大于3cm的肿瘤应手术治疗;而小于3cm的无功能肿瘤可定期严密随访.     

肾上腺偶发瘤的临床探讨(附50例报告)

目的：探讨肾上腺偶发瘤的诊治经验方法；对我院1984年1月－2001年2月收治的50例肾上腺偶发瘤患者进行回顾性分析。结果：50例患者经内分泌功能测定，CT，B超，MRI及同位素髓质扫描等检查，内分泌功能性肿瘤19例（38．0％），不论肿瘤大小均行手术切除；无功能性肿瘤31例（62．0％），其中26例手术切除，8例为恶性，其中原发腺癌5例，转移性肿瘤3例，结论：对于肾上腺偶发瘤必须结合的内分泌检查，影像学检查及同位素扫描，以排除有无内分泌功能及是否为恶性，对有内分泌功能亢进或直径≥4cm或有恶性征象的肾上腺偶发瘤均考虑手术治疗，对无内分泌功能亢进或直径＜4cm且无恶性征象的肾上腺偶发瘤患者可定期随访。     

肾上腺偶发瘤128例临床分析

目的 提高肾上腺偶发瘤的早期诊断与鉴别诊断水平,指导临床治疗.方法 回顾性分析1996年3月至2010年3月在我院健康体检或因肾上腺以外疾病就诊而发现的128例肾上腺偶发瘤患者的资料.男60例,女68例.年龄20～75岁,平均50岁.肿瘤直径＜3 cm者63例,3～6cm者56例,＞6 cm者10例.128例患者均行血生化、电解质和肾上腺皮、髓质代谢检测及腹部超声、CT检查;6例行MRI检查.128例均行手术治疗.结果 128例术后病理诊断肾上腺皮质腺瘤85例,嗜铬细胞瘤13例,肾上腺囊肿8例,神经节瘤、髓样脂肪瘤各7例,肾上腺皮质结节状增生4例,肾上腺皮质癌2例,肾上腺皮质嗜酸细胞瘤、神经鞘瘤、肾上腺脂肪肉瘤各1例.其中1例嗜铬细胞瘤患者术中死于低血压休克,未计入总例数.结论 肾上腺偶发瘤术前定性诊断困难,对于直径＞6 cm及功能性偶发瘤应积极手术治疗.

Abstract：

Objective To improve the early diagnosis and differential diagnosis of adrenal incidentalomas to guide clinical management of this disease. Methods One hundred and twenty-eight cases were diagnosed as adrenal incidentalomas due to health examination or treatment of other than adrenal disease,including 60 males and 68 females,whose ages were between 20 and 75 years,with a mean age of 50 years.Tumor diamer:＜3 cm 63 cases,3-6 cm 6 cases,＞6 cm 10 cases.128 patients all had biochemical and electrolyte examination,adrenal cortex and medulla biochemical testing,abdominal ultrasound and CT examination,6 cases with MRI examination.Surgery and post operative pathological examination were performed in all patients. Results Post operative pathology finally diagnosed adrenocortical adenoma in 85 cases,pheochromocytoma in 13 cases,adrenal cyst in 8 cases,paraganglioma and myeiolipoma in 7 eases respectively,adrenal nodular hyperplasia in 4 cases,adrenocortical carcinoma in 2 cases,adrenoconical oncocytoma,cellular Schwannoma and adrenal liposarcoma in 1 case,respectively.One case of pheochromocytoma patients died of intraoperative hypotension,which is not included in the total number. Conclusions The preperative diagnosis of adrenal incidentalomas is difficult.For adrenal incidentalomas with diameter more than 6 cm and those with endocrine function,early surgicM treatment is recommended.     

肾上腺偶发瘤的诊断与外科治疗原则

随着健康体检的普及以及医学影像技术的不断发展,肾上腺偶发瘤已成为一种比较常见的肿瘤。尽管大多数偶发瘤为良性、无功能性肾上腺皮质腺瘤,但如何进行合理有序的诊断、鉴别肿瘤的良恶性、判断肿瘤的功能状态、掌握手术适应证、正确选择治疗方法、避免不必要的外科手术等问题,均需引起泌尿外科医生的高度重视。本文就上述问题进行了详细讨论。     

1,161 patients with adrenal incidentalomas: indications for surgery

Background and aims The aim of this study is to analyze the clinical data and criteria for surgery in a group of over 1,100 patients with adrenal incidentalomas (AI) observed at the Department of Endocrinology. Patients and methods The material consisted of 1,161 patients (842 women and 319 men, 10–87 years old) with AI ranging in size from 1.0 to 23.0 cm. The methods included clinical examination, imaging studies, hormonal determinations in the blood and in the urine as well as histological and immunocytochemical investigations in 390 patients treated by surgery. Results Basing on these studies, we diagnosed 112 patients with primary malignant adrenal tumors (100 with carcinoma), 45 with metastatic infiltrations, and 1,004 with probable benign AI. Imaging phenotypes (especially high density on computed tomography, CT) were characteristic of malignant and chromaffin tumors. Subclinical adrenal hyperactivity was found in 8% of the patients with pre-Cushing’s syndrome as the most frequent form (6.5%). Chromaffin tumors were detected in 3%. Conclusions (1) Indications for surgery include malignant tumors (both primary and metastatic), tumors with subclinical hyperfunction, and chromaffin tumors. High density on CT, >20 HU, appeared to be an important indication for surgery. (2) A slight prevalence of oncological indications over endocrinological indications (14 vs. 11%) was found. Supported by a 501-2-2-07-45/01 and 501-1-1-07-16/06 CMKP Grant.     

偶发肾上腺肿瘤随访期间的危险性因素

目的　探讨偶发肾上腺肿瘤随访观察期间的危险性因素。　方法　通过单因素分析方法对 4 3例偶发肾上腺肿瘤病人危险因素进行筛选 ,进行Logistic回归多因素分析。　结果　经过平均 (4.0± 1.2 )年的随访观察 ,2 1例施行手术治疗 ,其中恶性肿瘤 4例。多因素分析显示肿瘤大小 (P=0 .0 18)和激素或其代谢产物异常 (P =0 .0 39)是偶发肾上腺肿瘤进一步手术治疗的危险因素。　结论　危险因素分析对于衡量手术风险与恶性倾向的关系有重要意义。     

后腹腔镜解剖性肾上腺肿瘤切除术38例临床分析

[摘要] 目的 评价后腹腔镜解剖性肾上腺肿瘤切除术的临床价值。方法 对本科2005年3月至2009年6月开展的38例后腹腔镜解剖性肾上腺肿瘤切除术进行分析。38例中22例为皮质醇腺瘤,14例为醛固酮腺瘤,2例嗜铬细胞瘤。结果 38例手术均获成功。手术时间45～130min,平均90min;失血量25～90mL,平均55mL,术中及术后均未输血。结论 后腹腔镜肾上腺肿瘤切除术具有对组织损伤小、出血少、术后恢复快、并发症少等优点,为肾上腺良性肿瘤的首选方法。     

Laceration of a benign adrenal adenoma mimicking a splenic rupture

Lacerations of adrenal tumors are very rare events and have been described for myelolipoma, pheochromocytoma, and cortisol-producing adenoma. We report on a patient who was admitted with suspected splenic rupture. Computed tomography showed a mass 14 cm in diameter adjacent to the spleen, but selective angiography revealed blood supply by the left suprarenal artery. A ruptured adrenal tumor was therefore diagnosed and resected. No hormone production was detected. Histologically a benign adrenal adenoma was found. Frequency, diagnosis and therapy of adrenal masses are discussed. Received: 17 June 1997     

Ancient schwannoma and myelolipoma coexist in an adrenal incidentaloma

Ancient schwannoma is rare in the adrenal gland and so is myelolipoma. These two uncommon tumors existing together in one adrenal incidentaloma is extremely rare, and have gone unreported in the literature to date. We describe a 47-year-old female case of ancient schwannoma and myelolipoma in a left adrenal incidentaloma. The patient was obese with diabetes mellitus. Chronic epigastralgia and acute hepatitis related to cholelithiasis was present. Abdominal computed tomography depicted a 7-cm left adrenal incidentaloma. Fine-needle biopsy for diagnosis is challenging on retrospective reviews. Due to the malignant potency of the tumor and symptomatic cholelithiasis, laparoscopic left adrenalectomy and cholecystectomy were performed simultaneously. The only way to definitely diagnose adrenal schwannoma is by immunohistochemical examination which exhibits positive for S-100 protein, but negative for CD34, desmin, smooth muscle actin, and synaptophysin as in our case. We also discuss clinical, pathological, and image characteristics of adrenal schwannoma and myelolipoma in the literature.     

肾上腺原始神经外胚层肿瘤临床及病理分析

目的 分析肾上腺原始神经外胚层肿瘤(PNET)的临床及病理特点. 方法肾上腺PNET患者4例.男2例,女2例.平均年龄24(21、22、24、30)岁.常规实验室及内分泌检查无阳性发现.B超、CT检查示肾上腺区边界欠清的巨大囊实性软组织肿块,直径平均12(8～17)cm. 结果 1例穿刺活检确诊后拒绝治疗,6个月后死亡;1例手术探查后行减瘤术,术后8个月死亡;行肿瘤根治性切除治疗2例,术后1个月出现远处转移1例,肿瘤局部复发1例,4例病理学检查光镜下可见典型的Homer-Wright菊形团,免疫组织化学染色CD99阳性.病理诊断均为PNET. 结论 肾上腺PNET是一种罕见的原始神经外胚叶来源肿瘤,好发于青年,临床及影像学无特殊表现,确诊依据病理学检查.肿瘤恶性度高,进展迅速,预后极差.