肾上腺皮质腺癌的诊断与治疗(附16例报告)

目的　对肾上腺皮质腺癌临床诊治进行回顾分析 ,提高对肾上腺皮质腺癌的诊断和治疗水平。方法　本组患者中有分泌功能肿瘤 10例 ,表现为Cushing综合征 8例 ,女性男性化表现 2例 ,无分泌功能 6例。B超、CT和MR等影像学检查均显示腹膜后肿块 ,其中 9例浸润周围组织、血管或淋巴结 ,5例出现远处转移。无远处转移的 11例在全麻下行手术治疗 ,7例完整切除肿瘤 ,4例部分切除或包膜内剜除。另 5例行局部化疗和肿瘤动脉栓塞治疗。结果　经 1～ 5年随访 ,7例完整切除肿瘤中有 4例生存 ,4例部分切除肿瘤中 1例生存 ,其余 6例手术患者和未经手术的 5例患者均已死亡。结论　早期诊断、及时手术行肿瘤全切除是目前治疗肾上腺皮质腺癌最有效的方法。完整切除肿瘤者生存期明显好于部分切除或姑息性治疗者。其预后与肿瘤分期、手术情况及病理检查结果密切相关。肾上腺皮质腺癌辅助治疗不能有效提高患者生存率。

THE DIAGNOSIS AND TREATMENT FOR ADRENOCORTICAL CARCINOMA (REPORT OF 16 CASES)

Objective: To improve the diagnosis and the treatment with adrenocortical carcinoma. Methods: 10 tumors are functional with excess hormone production and 6 carcinomas are nonfunctional. B ultrasound, CT and MR revealed the retroperitoneal mass. 9 cases had the evidence of adjacent tissue, vessels or lymph nodes invasion. Metastasis occurred in 5 cases. Eleven patients received the operation, among which seven had the operation of excising the tumor completely and four partially or under the envelope. Five patients received the therapy of local chemotherapy and embolizing of the artery. Results: All the cases were followed up 1 to 5 years. Four patients undergoing complete resection and one patient undergoing partial resection are still alive and all the other patients have died. Conclusion: Diagnosis of adrenocortical carcinoma at early stage and the tumor resected completely is potentially curative treatment. Adjuvant therapy couldn′t prolong the suvival.