非肿瘤性肾上腺囊性病变的临床分析

目的分析肾上腺囊肿和血肿等非肿瘤性囊性病变的临床特点。方法回顾性分析2000年1月—2009年10月在上海交通大学医学院附属瑞金医院泌尿外科经过手术切除的肾上腺肿块标本共1250例,收集其中46例(3.68%)经过病理检查证实的单纯性肾上腺囊肿和血肿的病例进行重点分析。术前患者均进行了内分泌功能检查和影像学(B超、CT、MRI和腹部平片加静脉肾盂造影)检查,术后进行病理诊断。结果 46例患者术前内分泌功能检查均无异常。术前影像学诊断30例(65.2%)为肾上腺囊肿,16例(34.7%)肿块性质不能确定。术中显示,肿块大小3.0cm×2.5cm～7.6cm×8.7cm;其中单纯肿块切除41例,肿块加肾上腺部分切除5例。所有患者术后随访8个月～9.5年,均未见复发。结论单纯性肾上腺囊肿经临床、影像学和实验室检查后大多可明确诊断,但部分肾上腺囊肿和肾上腺血肿易误诊为肾上腺实性肿瘤。具有症状的肾上腺囊肿或者性质不明的囊性肿块应行探查;无法明确病变性质的囊性肿块,需按静止性嗜铬细胞瘤做术前准备。

Clinical analysis of nonneoplastic adrenal cystic lesions

Objective To explore the clinical characteristics of nonneoplastic cystic lesions such as adrenal cysts and hematomas. Methods One thousand two hundred and fifty samples of adrenal masses resected by Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine between January 2000 and October 2009 were retrospectively analysed, and 46 (3.68%) of the cases were confirmed as simple adrenal cysts or hematomas by pathological examinations, and were further analysed. All patients underwent endocrinal examinations and imaging examinations such as B ultrasound, CT, MRI and plain abdominal radiograph plus intravenous pyelography before operation, and pathological diagnosis was made after operation. Results There were no abnormal findings in endocrinal examinations before operation in 46 patients. Thirty cases (65.2%) were diagnosed as adrenal cysts by imaging diagnosis before operation, while the other 16 cases were undetermined. The size of masses ranged between 3.0 cm×2.5 cm to 7.6 cm×8.7 cm. Forty-one patients underwent simple mass resection, and 5 patients experienced mass resection plus partial adrenalectomy. Patients were followed up for 8 months to 9.5 years, and no recurrence was observed. Conclusion Most simple adrenal cysts can be defined by clinical, radiological and laboratory examinations before operation, while some adrenal cysts and hematomas may be wrongly diagnosed as adrenal tumors. The exploration for symptomatic adrenal cystic lesions is needed, and cystic lesions without confirmation should be taken as pheochromocytomas in preparation before operation.