肾上腺肿瘤的影像学诊断与临床治疗(附117例报告)

目的总结肾上腺肿瘤的影像学诊断及外科治疗经验.方法应用比较影像学方法,对117例患者的各种影像学检查方法的定位、定性诊断正确率及治疗结果进行分析.结果B超、CT、MRI定位准确率分别为84.6%、90.6%、98.1%,术前定性准确率为39.2%、69.6%、79.6%.综合影像检查定位、定性准确率100.0%及87.5%.手术切除107例,其中巨大肿瘤(体积＞10cm×5cm×4cm)30例.9例肾上腺转移癌采取超声引导下穿刺硬化或介入性治疗.1例未手术.结论肾上腺肿瘤影像学检查B超可作为筛选手段,CT、MRI定位准确率高,定性准确率MRI略高于CT.综合影像学检查可发挥互补作用.正确的手术切口选择是手术成功的要素之一.围手术期充分准备是减少并发症的保证.腹腔镜B超技术具有术中诊断作用并可指导手术方案的制定和修改.     

肾上腺髓性脂肪瘤的诊疗(附9例报告)

目的:探讨肾上腺髓性脂肪瘤的诊断与治疗方法.方法:回顾性分析9例肾上腺髓性脂肪瘤患者的临床资料,并总结其诊断和治疗经验.9例中,7例无症状,1例有腰部不适,1例血压增高.B超与CT诊断8例,1例误诊为肾错构瘤.肿瘤发生于左侧肾上腺区4例,右侧肾上腺区5例,开放手术8例,腹腔镜手术1例.结果:肿瘤直径5～11cm,术后病理检查证实均为肾上腺髓性脂肪瘤.术后随访6个月～5年,无肿瘤复发.结论:肾上腺髓性脂肪瘤可依靠B超、CT或MRI等影像学检查诊断,手术切除肿瘤安全有效,腹腔镜手术较开放手术更有优越性.     

肾上腺髓样脂肪瘤6例报告及文献复习

目的：探讨肾上腺髓样脂肪瘤的诊断、治疗。方法：收治6例肾上腺髓样脂肪瘤的患者。4例行B超和MRI检查,3例行CT检查。3例行肾素-血管紧张素-醛固酮和皮质醇的测定;2例行儿茶酚胺的测定。6例患者全部接受手术治疗,其中腹腔镜手术切除4例,开放手术2例。结果：6例手术均获得成功。术后病理均诊断为肾上腺髓样脂肪瘤。术前具有的相关症状,术后均消失。5例术后获得随访时间为3个月～3年,均未见复发。结论：肾上腺髓样脂肪瘤术前诊断主要依赖于影像学检查;在治疗上有症状者宜手术切除,无症状且肿瘤直径大于4cm者可考虑手术,手术方式以腹腔镜手术为首选。     

肾上腺节细胞神经瘤的诊断与治疗

目的:探讨肾上腺节细胞神经瘤的诊断与治疗.方法:主要采用B超、CT及MRI等影像学检查对10例肾上腺节细胞神经瘤患者做出诊断,开放手术或腹腔镜手术切除肿瘤.结果:手术顺利,仅2例术中血压波动.肿物最大约6.0 cm×6.5 cm×6.5 cm,最小约2.5 cm×2.5 cm×2.0 cm,病理报告肾上腺节细胞神经瘤.术后血压正常,恢复良好,随访1～6年,未见复发.结论:肾上腺节细胞神经瘤多无特异性临床表现,诊断主要靠影像学检查,手术切除预后良好.     

肾上腺髓样脂肪瘤3例报告并文献复习

目的探讨肾上腺髓样脂肪瘤的临床、影像学及病理特点。方法回顾性分析2000年1月～2011年12月3例肾上腺髓样脂肪瘤患者的临床资料并复习相关文献。患者年龄分别为53、67、73岁,平均64岁,男性1例,女性2例,左侧2例,右侧1例,肿瘤直径2.5～11cm。结果 2例患者经后腹腔镜肾上腺肿瘤切除,1例经腹开放手术切除,术后病理检查均证实为肾上腺髓样脂肪瘤。随访6个月至2年未见复发。结论肾上腺髓样脂肪瘤的诊断主要依靠B超、CT和MRI,确诊需经病理学检查证实。手术切除是主要的治疗方法,症状明显或瘤体直径〉4cm者应尽早手术。     

肾上腺嗜铬细胞瘤的诊断与手术治疗

目的：提高肾上腺嗜铬细胞瘤的诊断与外科治疗水平。方法：对109例经手术治疗的肾上腺嗜铬细胞瘤患者的临床资料进行回顾性分析，其中具有典型儿茶酚胺症临床表现者104例，24h尿VMA定性检查106例，99例增高，阳性率为90．8％，B超、CT及MRI定位诊断阳性率分别为89．0％、92．7％及100％。106例经开放手术切除肿瘤，3例行后腹腔镜肿瘤切除术。结果：经病理检查证实，良性102例(93．6％)，恶性7例(6．4％)，本组无手术死亡病例。结论：肾上腺嗜铬细胞瘤主要根据临床表现、生化定性检查及影像学定位检查明确诊断。手术切除肿瘤是唯一有效的措施，术前充分准备是确保手术成功的重要因素。应用腹腔镜技术切除肾上腺肿瘤具有广阔的应用前景。     

肾上腺髓性脂肪瘤21例诊治分析

目的探讨肾上腺髓性脂肪瘤的诊断与治疗方法。方法回顾性分析21例肾上腺髓性脂肪瘤患者的临床资料,总结诊断和治疗经验。21例病例中,14例无症状,5例腰痛,2例血压升高。B超、CT诊断20例,1例因肿瘤破裂出血误诊为肾上腺错构瘤。肿瘤发生于左侧肾上腺区7例,右侧肾上腺区12例,双侧肾上腺区2例。开放手术5例,腹腔镜手术16例。结果 21例手术均获成功。肿瘤直径4~12cm,术后病理检查证实均为肾上腺髓性脂肪瘤。术后随访3个月~5年,无肿瘤复发。结论肾上腺髓性脂肪瘤可依靠影像学检查诊断,手术切除肿瘤安全有效,手术方式以腹腔镜为首选。     

肾上腺节细胞神经瘤的诊治(附7例报告)

目的探讨肾上腺节细胞神经瘤的诊治。方法依据B超、CT及MRI等影像学检查结果对7例肾上腺节细胞神经瘤患者进行诊断,开放手术或腹腔镜手术切除肿瘤。结果手术顺利,仅1例术中血压波动。术后病理报告肾上腺节细胞神经瘤。术后血压正常,恢复良好,随访6个月～5年,未见复发。结论肾上腺节细胞神经瘤多无特异性临床表现,诊断主要依靠影像学检查,手术切除预后良好。     

后腹腔镜手术切除巨大肾上腺肿瘤

目的探讨后腹腔镜手术切除巨大（≥6cm）肾上腺肿瘤的可行性。方法2002年6月～2008年6月对30例直径≥6cm巨大肾上腺肿瘤行后腹腔镜切除手术。采用健侧卧位,用自制的气囊扩张后腹腔,分别在腋后线肋缘下、腋中线髂嵴上2cm及腋前线肋缘下穿刺,置入trocar。肿瘤切除后用标本袋取出肿瘤,留置引流管。结果30例后腹腔镜手术成功,无中转开放手术。平均手术时间100min（65～185min）,术中出血量平均80ml（50～250ml）。30例术后随访3～36个月,平均18.5月,无局部复发。结论对于无明显禁忌证的肿瘤,后腹腔镜手术切除巨大肾上腺肿瘤可行、安全,肿瘤直径并不是手术的决定性因素。     

肾上腺肿瘤的影像学诊断(附350例报告)

目的　提高肾上腺肿瘤的诊断水平。　方法　回顾 1 975年 5月～ 1 998年 5月收治的肾上腺肿瘤 35 0例临床资料 ,总结影像学检查与临床症候群、病理组织类型的关系。　结果　B超和CT对肾上腺肿瘤的定位诊断率分别为 85 %和 96 %。在皮质腺瘤、嗜铬细胞瘤及肾上腺皮质癌等不同的组织类型间 ,CT和MRI具有相对特异的表现。　结论　影像学检查可以提供肾上腺肿瘤的定位和定性诊断 ,在诊断和治疗中具有重要的应用价值。     

Can dynamic gadolinium-enhanced magnetic resonance imaging with chemical shift studies predict the status of adrenal masses?

Endoscopic adrenalectomy represents the new gold standard in the surgical treatment of benign adrenal lesions up to 6 cm. In some cases lesions larger than 10 cm have been removed laparoscopically to offer the patient the advantages of the minimally invasive technique. The larger the diameter of an adrenal lesion, the greater the probability of malignancy. In a prospective study 130 consecutive patients (88 women, 42 men; mean age 47.8 years) with 137 adrenal lesions earmarked for surgery underwent preoperative gadolinium-enhanced magnetic resonance imaging (MRI) with chemical shift studies (CSS). The aim of this study was to predict the status (benign, borderline, malignant) of adrenal lesions by MRI irrespective of tumor size. There were 14 patients with malignant tumors, 3 had borderline tumors (epithelial tumors with high malignant potential), and the remaining 120 had benign adrenal lesions. Five malignant lesions (36%) had a diameter < 6 cm. MRI correctly predicted 11 of 14 malignant tumors (1 malignant pheochromocytoma and 2 adrenocortical carcinomas had false-negative results), 117 of 120 benign lesions, and 2 of 3 borderline lesions. All but two malignant tumors were operated on using open surgery; 82 (68%) of 120 benign adrenal lesions were treated using the transperitoneal laparoscopic approach. Tumor size alone is not suitable for predicting the status of adrenal lesions. Dynamic gadolinium-enhanced MRI with CSS can predict the status of at least 95% of adrenal lesions. Tumors > 6 cm classified as benign by preoperative MRI may be removed laparoscopically by endocrine surgeons experienced in endoscopic adrenalectomy.     

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.     

肾上腺髓性脂肪瘤26例临床分析

目的探讨肾上腺髓性脂肪瘤的诊断与治疗方法。方法回顾性分析26例肾上腺髓性脂肪瘤患者的临床资料,并总结其诊断和治疗经验。26例中,16例无症状,8例有腰部或上腹部不适、疼痛,2例出现血儿茶酚胺水平增高;B超与CT各诊断24例,另2例诊断为肾血管平滑肌脂肪瘤;8例行磁共振成像(MRI)检查,均诊断为肾上腺髓性脂肪瘤;3例行腹主动脉造影检查提示肿瘤与肾脏无关。肿瘤发生于左侧14例,右侧11例,双侧1例,单纯行肿瘤切除治疗16例,肿瘤并肾上腺全切除10例,其中4例初次诊断时肿瘤小于5cm,随诊6个月、9个月及2年肿瘤增大后手术治疗。结果肿瘤直径5～10cm,术后病理检查证实均为肾上腺髓性脂肪瘤,其中Ⅰ型9例,Ⅱ型17例。术后随访6～28个月,无肿瘤复发。结论肾上腺髓性脂肪瘤可依靠B超、CT或MRI的影像学检查诊断,对直径>5cm的肿瘤宜手术切除。     

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.     

Diagnosis and surgical treatment of adrenal tumors

Adrenal surgery is necessary for the management of functioning adrenal tumors, such as aldosterone-producing adenoma, cortisol-producing adenoma, and pheochromocytoma. The role of adrenal imaging in primary hyperaldosteronism is to separate the surgically resectable unilateral aldosteronoma from bilateral hyperplasia. Once the clinical diagnosis of primary hyperaldosteronism is confirmed, adrenal computed tomography (CT) with 3-mm sections should be the first imaging study. If the results of CT and NP-59 scintigraphy are equivocal, adrenal venous sampling is necessary. Cortisol-producing adrenocortical adenomas are seen as adrenal masses 2.5 cm or larger in diameter in CT scanning. When an adrenal mass measures more than 5 cm in diameter, a functioning adrenal carcinoma should be considered. Symptomatic pheochromocytomas are almost always 2 cm or larger. On MR scanning, pheochromocytomas are extremely bright on T2-weighted images. In patients with ectopic pheochromocytomas, 131I-MIBG scintigraphy should be mandatory. In the past decade, laparoscopic adrenalectomy has replaced open adrenalectomy as a standard operative procedure for benign adrenal tumors. Adrenal-sparing laparoscopic surgery has recently become a feasible option in patients with hereditary bilateral pheochromocytomas.     

Clinical significance of the large adrenal mass

Current clinical teaching indicates that large (greater than 5 cm in diameter) adrenal masses are often malignant. In a retrospective analysis of patients studied between 1977 and 1988 with computed tomography (CT), adrenal scintigraphy, and when available, magnetic resonance imaging (MRI) 45 were found to have adrenal masses greater than 5 cm (range 5-19 cm) in diameter. Thirty were benign (16 phaeochromocytomas, six adrenocortical adenomas, four adrenal cysts, two myelolipomas, an adrenal hematoma and a ganglioneuroma). Of 15 malignant masses, there were seven adrenocortical carcinomas, five adrenal metastases and three adrenal lymphomas. With the exception of the adrenal myelolipomas, cysts, and the ganglioneuroma neither CT nor MRI demonstrated sufficient diagnostic specificity to distinguish benign from malignant lesions. Functional scintigraphy with 131I-6-beta-iodomethyl-19-norcholesterol for suspected adrenocortical lesions and 131I-metaiodobenzylguanidine for suspected phaeochromocytomas frequently provided useful information.     

What adrenal incidentalomas are to be operated?

AIM OF THE STUDY: The goal of this retrospective study was to recognize the incidence of adrenal tumors called incidentalomas, that are in fact symptomatic or hormone secreting tumors, to assess if the diagnostic criteria proposed in the literature are reliable for adrenal tumors found incidentally. PATIENTS AND METHOD: The records concerned 147 patients operated between April 1981 and December 2000 for an adrenal mass measuring 3 cm in diameter and larger on CT scan. Clinical and laboratory findings as well as hormone levels and imaging examinations (CT Scan, IRM, scintigraphy) were correlated with operative findings and results of histologic examinations. One hundred and three patients were operated by a traditional approach and forty four by videoendoscopic techniques. RESULTS: In 41 patients (28%), the tumors had to be classified as false incidentalomas (group 1) postoperatively. In 106 patients (72%), the nature of tumor was non definite. In this group 2, there were ten malignant tumors, two pheochromocytomas and 94 benign lesions. Age of patient, size of tumor, increase in size over time and radiological appearance represent criteria that are not reliable to separate malignant from benign tumors. CONCLUSIONS: Tumors of indeterminated and non specific nature only should be classified as incidentalomas. Imaging techniques as well as other criteria of malignancy cannot be relied upon to separate benign from malignant tumors. The risk even small of cancer or pheochromocytoma leads us to recommend excision of tumors > or = 3 cm in radiological diameter. The videoendoscopic approach is a good alternative to open operation in centers with this special expertise.     

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.