肾上腺髓性脂肪瘤的诊断与治疗

目的：探讨肾上腺髓性脂肪瘤的影像学特点和诊治方法.方法：肾上腺肿瘤患者12例.男5例,女7例.平均年龄48（33～64）岁.左侧4例,右侧8例.血压高2例.腰腹部疼痛1例,无特异性症状9例.行B超、CT及MRI检查.术前提示为肾上腺占位,其中肾上腺髓性脂肪瘤10例.嗜铬细胞瘤1例,肾上腺肿瘤1例.12例均行肾上腺肿瘤切除术,其中开放手术7例.腹腔镜手术5例.结果：12例手术均顺利完成.平均手术时间1.5 h,平均术中出血量50 ml.术后无明显外科并发症,平均7天顺利出院.切除肿瘤最小3.0 cm×3.5 cm×4.0 cm.最大6.5 cm×7.5 cm×8.0 cm.病理诊断均为肾上腺髓件脂肪瘤.术后随访0.5～8年（平均2年）.所有患者临床症状消失,B超及CT检查末见肿瘤复发及恶性变.结论：肾上腺髓件脂肪瘤多无特异性临床表现,术前诊断主要靠影像学检查,确诊依赖于病理检查 手术切除预后良好,其中腹腔镜手术创伤小,疗效满意,为治疗本病的理想方法.

Diagnosis and Treatment of Adrenal Myelolipoma

Objective：To evaluate the diagnosis and management of adrenal myelolipoma. Methods：Twelve cases of adrenal myelolipoma （5 males,7 females; mean age,48 years ） were reviewed . Of all cases, only 2 had hy pertension, 1 had back pain, and the rest were asymptomatic. The diagnosis of adrenal myelolipoma was set up by B-ultrasound, CT or MRI. Preoperative diagnoses were adrenal myelolipoma in 10 cases,pheochromocytoma in 1 case , adrenal tumor in 1 case. 12 cases are all underwent resection of adrenal tumors, including 7 cases of open surgery, laparoscopie surgery in 5 cases. Results： The operations were completed successfully. The average operation time was 15h, the average blood loss was 50 ml,and the average hospital stay after operation was 7 d. No surgical complications occurred. The tumor size was from 3.0 cm×3.5 cm× 4.0 cm to 6.5 cm×7.5 cm×8.0 cm,and the pathological reports showed adrenal myelolipoma. All the cases were followed up for 0.5 to 8 years, and there was no recurrence. Conclusions： Adrenal myelolipoma shows rarely specific clinical symptoms, and the diagnosis is mostly established by adrenal imaging examination. The surgical resection has an excellent effect, and laparoscopic operation could be as a good method because of its little trauma and quick recovery.