肾上腺皮质疾病的定性、定位诊断及外科治疗（附53例报告）

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、柯兴氏综合征皮质腺瘤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综合症,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。

The Accurate Diagnosis and Surgical Treatment for Adrenal Cortex Diseases(a Report of 53 Cases)

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 adrenocortical adenoma were undertaken the operation.They were cured after 5-year-follow-up.6 cases of adrenal cortical hyperplasia(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 observed after operation and one year later respectively.Both them needed to take adrenocortical hormone.1 cases of adrenalcortical carcinoma and 3 cases of adrenal metastatic tumor died of carcinomatous metastasis.Conclusions:The prognosis and effect of benign adrenocortical neoplasms was reliable while adrenocortical carcinoma was poor,so the surgeon must be certain of the diagnosis and the patient must be thoroughly prepared before undertaking the operation.