肾上腺偶发瘤（附16例报告）

１９９０年１０月～１９９４年１月收治肾上腺偶发瘤１６例，术前Ｂ超、ＣＴ及ＭＲ确诊为肾上腺囊肿４例，肾上腺骨髓脂肪瘤２例。术前诊断不明确者１０例中，肿瘤直径＜３．０ｃｍ４例为肾上腺皮质腺瘤；肿瘤直径３～６ｃｍ３例，为肾上腺髓质肿瘤；肿瘤直径＞６ｃｍ３例，２例为肾上腺皮质癌，１例为肾上腺嗜铬细胞瘤。肾上腺偶发瘤除直径＜３ｃｍ的肾上腺囊肿和骨髓脂肪瘤外均应手术治疗。     

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。     

肾上腺髓性脂肪瘤15例报告

目的：提高对肾上腺髓性脂肪瘤的认识。方法：回顾性分析15例肾上腺髓性脂肪瘤患者的临床资料并复习相关文献。结果：15例中，10例为偶发瘤，2例出现血儿茶酚胺浓度升高；术前均行CT或MRI检查，除1例未能明确诊断外，其余均确诊为肾上腺髓性脂肪瘤，术后均经病理检查证实为肾上腺髓性脂肪瘤。结论：肾上腺髓性脂肪瘤无特异性临床表现，绝大部分患者仅靠CT或MRI的特异性影像即能被明确诊断。对直径＜2．5cm的偶发瘤可随访观察，对直径＞5cm的肿瘤均应手术切除，术前宜行内分泌功能检测。     

无功能肾上腺肿瘤29例临床分析

作者１９８５年６月至１９９４年７月共收治无功能肾上腺肿瘤２９例。术前Ｂ超、ＣＴ及ＭＲＩ可定性者７例，其中肾上腺囊肿５例，肾上腺骨髓脂肪瘤２例。术前定性不明确者２２例，其中肿瘤直径＜３．０ｃｍ的８例均为肾上腺皮质腺瘤；直径３～６ｃｍ的６例均为肾上腺髓质肿瘤；肿瘤直径＞６ｃｍ的８例中，肾上腺皮质癌、转移癌、肾上腺嗜络细胞瘤各２例，肾上腺神经母细胞瘤、肾上腺淋巴结增殖症各１例。作者认为除直径＜３ｃｍ的肾上腺囊肿、肾上腺骨髓脂肪瘤外，其他肿瘤均应手术治疗。     

肾上腺偶发瘤（附21例报告）

为探讨肾上腺偶发瘤早期诊断及治疗措施，对１９７６～１９９４年收治的２１例肾上腺偶发瘤病例进行分析。其中早期３例为其他手术时偶然发现，另１８例为健康查体Ｂ超偶然发现。１６例经ＣＴ确诊为肾上腺肿瘤，所有病例均行手术并经病理证实。本组结果显示ＣＴ对确诊肾上腺占位病变有较高价值。在健康查体时应常规行肾上腺Ｂ超检查。确诊为恶性肿瘤、功能性肿瘤及直径大于３．５ｃｍ的肿瘤均应手术，术中应警惕无症状型嗜铬细胞瘤的潜在危险。小于３．５ｃｍ的肿瘤可行Ｂ超、ＣＴ随访。     

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52例临床分析

目的 提高肾上腺偶发瘤早期诊断与鉴别诊断水平，指导临床治疗。方法 本组52例均为健康体检发现的肾上腺偶发瘤。男35例，女17例，年龄23～65岁，平均42岁。均无高血压及内分泌紊乱的临床症状和体征。肿瘤直径≥3．0cm者33例。52例均行血生化、电解质检查，肾上腺皮、髓质代谢的生化检测及腹部超声、CT检查；6例行MRI检查，2例行PET检查，1例行肾上腺I—MIBG核素扫描。52例均行手术治疗。结果 肾上腺偶发瘤52例经病理证实皮质腺瘤27例，转移瘤7例，嗜铬细胞瘤5例，囊肿4例，原发性醛固酮瘤3例，神经鞘瘤2例，皮质癌1例，腹膜后神经母细胞瘤1例，腹膜后原发性淋巴瘤1例，神经节纤维瘤1例。影像学及实验室检查术前获正确诊断者14例(27％)。10例恶性肿瘤者中，5例肾上腺转移瘤者术后行化疗，6—10个月内死亡，余5例失访。42例良性病变者随访6个月～9年，未见肿瘤复发。结论 肾上腺偶发瘤术前定性诊断困难，应积极手术治疗。     

肾上腺偶发瘤的外科治疗选择

目的 探讨肾上腺偶发瘤的手术指征.方法 总结147例肾上腺偶发瘤患者资料,分析偶发瘤的手术指征,比较腹腔镜和开放性手术的适应证.147例患者中,恶性肿瘤19例(12.9%),平均直径(8.5±3.9)cm,≤4 cm者4例(21.1%),其中肾上腺皮质癌15例、恶性嗜铬细胞瘤4例;良性功能性肿瘤29例(19.7%),平均直径(4.1±2.1)cm,其中≥3 cm者22例(75.9%);19例良性嗜铬细胞瘤中24 h尿香草扁桃酸升高2例,5例醛固酮瘤中血钾稍低2例,5例亚临床库欣综合征腺瘤患者血皮质醇升高,均无明显内分泌异常症状;良性无功能性肿瘤99例(67.3%),其中肾上腺皮质腺瘤61例(61.6%).结果 147例均行手术治疗.腹腔镜下手术组102例,开放性手术组45例,2组肿瘤直径分别为(3.4±1.8)cm和(6.7±1.5)cm(P＜0,0001);手术并发症发生率分别为5.9%(6/102)和15.6%(7/45)(P=0.1103).腹腔镜中转开放手术5例(4.9%),主要见于黏连严重的恶性肿瘤或肿瘤直径＞6 cm者.结论 肾上腺偶发瘤常见类型为无功能肾上腺腺瘤、嗜铬细胞瘤、肾上腺皮质癌.可疑恶性、有内分泌功能、直径≥3 cm的肾上腺偶发瘤应积极手术治疗.腹腔镜手术创伤小、恢复快,为手术首选;肿瘤直径＞6 cm、黏连严重、可疑恶性者应以开放性手术为主.     

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.     

Adrenal incidentalomas: indications for surgery

Adrenalectomy represents the gold standard treatment for hyperfunctioning adrenal incidentaloma. In cases of silent adrenal masses, on the other hand, the surgical removal of an adrenocortical cancer entails the sacrifice of a large number of safe benign masses, and in most cases surgery is therefore unjustified. The aim of this paper was to clarify the surgical indications for adrenal incidentaloma by reviewing our experience in comparison with the main reference literature. Over the period from 1995 to 2001 we managed 40 cases of incidentaloma. US and CT abdominal scans, adrenal scintigraphy and biochemical tests were performed on an outpatient basis. Seven pre-Cushing syndromes were removed. Ten incidentalomas measured 4 cm or more in diameter: 5 of these were operated on and in 5 cases surgery was not feasible or was refused. Only one malignant mass was detected (an angiosarcoma). Four postoperative minimal complications (18.7%) were observed. The follow-up (median: 48 months) was uneventful. The surgical approach was traditional in 11 cases and laparoscopic in 1 case. Surgery should be considered mandatory in cases of hyperfunctioning adrenal masses in the presence of suspect radiological evidence, in cases of discordant CT and scintigraphy findings and when the maximum diameter is 4 cm or more.     

Management of incidentalomas of the adrenal gland in an Indian hospital set-up between 1991 and 2000

The use of imaging techniques and their increasing sensitivity have resulted in increased detection of incidentalomas of the endocrine organs. The aim of our study was to review the currently used evaluation schemes and the outcomes of surgical and conservative management of adrenal incidentalomas at an Indian center. Fifty-eight cases of adrenal incidentalomas diagnosed and treated at the Govt. General Hospital, Chennai, and private practice were reviewed. Ultrasonogram of the abdomen was the most frequently used investigation (88%). The common complaint was upper abdominal discomfort. The mean duration of treatment of symptoms before diagnosis was 3.5 months. Thirty-three cases underwent adrenalectomy. The cases not subjected to resection were followed every 6 months for 2 years and follow-up ceased if no increase in size was detected. Of these, two patients required subsequent adrenalectomy. Thirty-six of these tumors were eventually detected to be nonfunctioning adenomas, of which 15 underwent resection because of size >3 cm. Cortical carcinoma was detected in nine patients, pheochromocytoma in seven, myelolipoma in one, metastatic tumor in one, and cyst, ganglioneuroma, and tuberculoma in four. Of these, 20 developed features of hypersecretion during preparation for surgery. In tumors between 3 and 5 cm, in view of noncompliance of patients to repeated follow-up and cost factors, surgery was considered the most effective treatment option. There is a need for prospective studies to formulate diagnostic and treatment strategy.     

Adrenal Incidentalomas: Experience in a Developing Country

BACKGROUND: The incidence of adrenal incidentalomas is rising worldwide. There is a concern about malignancy in large incidentalomas. There are few published articles from developing countries on this entity. The aim of this study was to analyze the clinical presentation, functional status, and final diagnosis of adrenal incidentalomas and, in particular, to look into the incidence of adrenal cortical carcinoma (ACC) in large adrenal incidentalomas managed at a tertiary referral hospital in northern India. METHODS: This is a retrospective study (January 1991-December 2005) of 59 patients with adrenal incidentaloma managed at our department. The mean tumor diameter was 7.8 +/- 4.0 cm. In all cases, clinical details, radiology findings, laboratory findings, intervention details, histology findings, and follow-up data were noted. Six patients in which the mass was ultimately found to arise from extra-adrenal tissue were excluded from final analysis RESULTS: Mean age of the patients was 46 +/- 12 years (M:F = 1:1.1). The incidentaloma measured more than 3 cm in 91% of cases and more than 6 cm in 70% of cases. The clinical scenarios leading to detection of incidentaloma included abdominal (56.6%), genitourinary (24.5%), and systemic complaints (15.1%) and routine medical checkup (3.7%). Most of cases were found by ultrasonography (n = 41), and remaining by CT scan (n = 10), and MRI (n = 2). The incidence of functioning tumors was 41.5% (hypercatecholinism 37.7 % and hypercortisolism 1.9%). Forty-nine patients were operated on. The important final pathology included ACC (7.5%), pheochromocytoma (PCC) (43%), adrenal cysts (13.2%), myelolipoma (11.3%), and inflammatory lesions (9.4%). CONCLUSION: In our experience, the incidence of PCC was high among large adrenal incidentalomas while that of ACC was lower than expected. Inflammatory lesions contribute to a significant number of cases of incidentaloma in developing countries. Adrenalectomy is a justified procedure for large incidentalomas, although the concern may not always be an underlying malignancy.     

肾上腺意外瘤126例分析

目的 探讨肾上腺意外瘤的诊断和治疗方法。方法对126例肾上腺意外瘤进行分析,其中98例行手术治疗。结果各类意外瘤中,以腺瘤为最多,共52例(41．3％);43例(34．1％)有功能,以嗜铬细胞瘤及原发性醛固酮增多症为主;无功能腺瘤的最大直径均在6cm以下,皮质癌均在6cm以上。结论术前应明确意外瘤的功能状态及良恶性。对于无功能意外瘤,肿物大小是判断其良恶性及决定手术与否的主要指标。     

后腹腔镜治疗肾上腺偶发瘤13例报告

目的:探讨后腹腔镜治疗肾上腺偶发瘤的临床应用及疗效。方法:采用后腹腔镜手术切除肾上腺偶发瘤13例。结果:平均手术时间135min,平均出血量67ml,术后下床时间平均2天。术后恢复良好,平均6天出院,无严重并发症发生。结论:后腹腔镜手术治疗肾上腺偶发瘤是一种安全、有效的术式,具有手术创伤小、并发症少及患者恢复快等优点。     

肾上腺偶发瘤临床分析

目的 总结肾上腺偶发瘤的临床、内分泌及病理学特点. 方法回顾性分析97例病理确诊肾上腺偶发瘤患者的临床资料.男53例,女44例.平均年龄45岁.肿瘤位于左侧38例、右侧52例、双侧7例.有较完整内分泌检测资料者74例.肿瘤最大直径由B超确定8例、CT确定54例、MRI确定35例. 结果 97例中恶性肿瘤20例(20.6%),其中肾卜腺皮质癌12例、恶性嗜铬细胞瘤3例、转移癌2例,肉瘤、神经母细胞瘤、恶性神经鞘瘤各1例;肾上腺皮质腺瘤26例(26.8%),良性嗜铬细胞瘤21例(21.6%),髓脂肪瘤9例(9.3%),肾上腺囊肿13例(13.4%),节细胞神经瘤5例(5.2%),神经纤维瘤3例(3.1%).高血压病患者40例(41.2%),功能性偶发瘤21例(28.4%).肿瘤直径<4 cm者25例(25.8%)、4～6 cm者33例(34.0%)、>6 era者39例(40.2%).肿瘤直径<4 cm者中恶性肿瘤仅1例(4%).恶性肿瘤直径(9.9±4.6)cm,良性肿瘤直径(5.6±3.2)锄(P=0.01).恶性肿瘤中直径>6 cm者15例(75.0%),良性肿瘤中27例(35.1%,P=0.001).恶性肿瘤患者体质量减轻者5例(25.0%),良性肿瘤者中2例(2.6%,P==0.004). 结论 肾上腺偶发瘤中皮质腺瘤、良性嗜铬细胞瘤和恶性肿瘤居前3他,偶发瘤均应进行详细的内分泌检测,肿瘤直径<4 cm足筛选无内分泌异常的偶发瘤随访时的一项重要指标.     

肾上腺偶发瘤27例

目的 提高对肾上腺偶发瘤的诊治水平。方法 对27例肾上腺偶发瘤的临床资料进行分析。结果 27例中,B超诊断21例,占77.8％,CT及MRI检查发现6例。27例均行手术治疗,效果满意。结论 在健康查体时应常规作肾上腺B超,对肾上腺偶发瘤直径>2.0cm者应手术治疗,而直径<0.2cm者可定期随访。