肾上腺皮质疾病53例外科诊治体会

目的:探讨肾上腺皮质疾病的定性、定位诊断及围手术期处理方法,提高肾上腺皮质疾病的术前确诊率及外科诊疗水平。方法:对53例肾上腺皮质疾病患者的临床表现、术中经过、术后病理及随访结果进行回顾性分析。结果:原发性醛固酮增多症皮质腺瘤20例、柯兴综合症皮质腺瘤15例、无功能肾上腺皮质瘤8例,经手术后5年随访均已治愈,未见复发;肾上腺皮质结节样增生6例,其中左侧增生3例、右侧增生1例,双侧增生2例。4例作患侧肾上腺全切除,术后1年随访其临床症状及体征均有好转;2例作左侧肾上腺全切除、右侧肾上腺大部切除,术后出现肾上腺皮质机能危象,1年后随访出现Nelson综合征,需要补充肾上腺皮质激素。肾上腺皮质癌及肾上腺皮质转移癌4例,术后1年2例因恶性程度高发生转移而死亡,另2例在5年内死亡。结论:良性肾上腺皮质肿瘤手术效果及预后满意;恶性肾上腺皮质肿瘤应早期确诊、及时手术探查以提高手术疗效;肾上腺皮质疾病除选择正确的手术方案外,还应配合适当的围手术期处理以保证手术经过顺利。

Diagnosis and Surgical Treatment Experience on the 53 of Adrenal Cortex Diseases

Objective:To study the accurate diagnosis and preoperative management for adrenal cortex diseases in order to increase the positive diagnostic rate and improve surgical treatment skill Methods:53 cases of adrenal cortex diseases were collected,and their clinical data such as symptoms,surgical operations,pathology and follow-up were analyzed retrospectively.Results:20 cases of primary aldosteronism,15 cases of Cushing's syndrome and 8 cases of nonfunctional adre- nocortical adenoma were undertaken the operation.They were cured after 5-year-follow-up.6 cases of adrenal cortical hyperpla- sia(left 3,right 1,bilateral 2),4 patients were underwent unilateral total adrenalectomy and the effects were significant, while another 2 cases were underwent partial adernalectomy/enucleation.Adrenal hypofunction and Nelson syndrome were ob- served after operation and one year later respectively.Both them needed to take adrenocortical hormone.1 cases of adrenalcorti- cal carcinoma and 3 cases of adrenal metastatic tumor died of carcinomatous metastasis.Conclusion:The prognosis and effect of benign adrenocortical neoplasms was reliable while adrenocortical carcinom(?) was poor,so the surgeon must be certain of the di- agnesis and the patient must be thoroughly prepared before undertaking the operation.