肾上腺转移癌21例临床分析

背景与目的:近年来肾上腺转移癌的发生率在临床上呈逐年上升趋势,但早期诊断、鉴别诊断有时仍比较困难。肾上腺转移癌是否需要手术切除、何时切除及怎样切除仍然存有争议。本研究旨在探讨肾上腺转移癌手术指征及腹腔镜下肾上腺切除的价值。方法:回顾性分析中山大学附属第一医院1997年3月至2004年3月收治的21例肾上腺转移癌的临床资料及复习有关肾上腺转移癌诊断与治疗方面的文献。结果:本组患者经B超和CT检查,对肾上腺肿物的诊断率分别为70.0%(7/10)与84.6%(11/13)。10例行肾上腺转移癌手术切除,其中4例患者于术后1个月至5年间行腹腔镜肾上腺转移癌切除,切缘均无癌细胞。患者生存1～67个月,中位生存时间18个月,其中1例患者行肾上腺转移癌切除术后67个月仍生存,2例失访。未手术组共11例,生存5～28个月,中位生存时间13个月,1例失访。两组生存率的差异无统计学意义(P=0.346)。结论:B超及CT是诊断肾上腺转移癌的重要检查方法。对转移癌局限在肾上腺包膜内、无局部淋巴结肿大、肾上腺外无转移的应尽可能的行手术治疗。而腹腔镜下肾上腺切除也是安全的、有效的。

Diagnosis and therapy of metastatic tumors in the adrenal gland--a report of 21 cases

BACKGROUND & OBJECTIVE: Recently, the occurrence of metastasis to the adrenal gland is increasing, while the early and differentiated diagnosis still remains difficult. Whether metastasis to the adrenal gland needs to be resected and when and how the resection should be done are controversial. This study was to explore the surgical indications of metastasis to the adrenal gland and the role of laparoscopic adrenalectomy in the treatment of this disease. METHODS: Clinical data of 21 patients with metastatic tumors in the adrenal gland, treated in Cancer Center of Sun Yat-sen University from Mar. 1997 to Mar. 2004, were analyzed retrospectively. Literature of the diagnosis and therapy was reviewed. RESULTS: The diagnosis rates of ultrasonography and spiral or thin-cut computed tomography (CT) were 70.0% (7/10) and 84.6% (11/13). Ten patients received adrenalectomy with negative resection margins, 4 of them received laparoscopic adrenalectomy. The patients survived for 1-67 months, with a median of 18 months. One patient was still alive 67 months after the adrenalectomy, and 2 was lost. Eleven patients received palliative operation or no treatment, 10 of them survived for 5-28 months with a median of 13 months, while 1 was lost during follow-up. The difference in survival rates between the 2 groups was not significant (P=0.346). CONCLUSIONS: Ultrasonography and CT are important diagnosis methods for metastatic adrenal cancer. No evidence of tumor invasion revealed by preoperative imaging studies, no adjacent lymphadenopathy and no extraladrenal metastasis are indications of adrenalectomy. Laparoscopic adrenalectomy is safe and effective for those well-selected patients.