自发性肾上腺出血

目的　提高自发性肾上腺出血的诊治水平。　方法　回顾性总结 1 1例自发性肾上腺出血患者的诊治资料。　结果　 1 0例仅表现为患侧腰痛 ,1例为输尿管癌术中发现肾上腺肿物。肾上腺功能均正常。B超检查 1 1例 ,3例表现为囊性肿物 ,其内可见点状、分隔样强回声 ,7例表现为低回声肿物 ,1例输尿管癌术前肾上腺B超正常。 1 0例CT扫描表现为卵圆形、边界清楚低密度病灶 ,CT值 34 .7～ 85 .0HU ,>50 .0HU者 6例 ,其中 1例可见液平面 ;增强CT扫描 3例 ,肿物无强化。MRI检查 3例 ,显示肾上腺区不均匀肿物 ,T1加权像为等信号 ,T2加权像为低信号。行肾上腺及肿物切除术 6例 ;行部分肾上腺及肿物切除术 5例。术后病理为肾上腺髓质内出血 ,血肿外包绕肾上腺组织。术后肾上腺皮质功能正常 ,随访 7个月～ 8年 ,无肾上腺皮质功能低下表现。　结论　B超、CT、MRI可以帮助诊断自发性肾上腺出血。双侧肾上腺出血、腰腹痛症状明显、单侧肾上腺出血但血肿 >5cm者应采取手术治疗 ,行部分肾上腺及血肿切除术 ,尽量保存血肿周围健康肾上腺组织。

Spontaneous adrenal hemorrhage

Objective To improve the effect of diagnosis and treatment in spontaneous adrenal hemorrhage. Methods Eleven cases of spontaneous adrenal hemorrhage were retrospectively summaried. Results Ten cases manifested lumbago in troubled side and 1 case was detected adrenal masses in operations of carcinoma of ureter.The functions of adrenal gland were all normal.Eleven were checked by ultrasound B of whom 3 cases had cystic masses, and strong echo of point or partition could be detected.Seven cases were manifested with low echo of masses,and 1 case of carcinoma of ureter was normal in ultrasound B before operation.Ten cases were scanned by CT.The focus was oval round shape and the border of focus was detected clearly.The value of CT ranged from 34.7 to 85.0 HU, and in 6 cases their values exceeded 50.0 HU.Among them,fluid plan could be seen in 1 case.Reinforcement CT was performed in 3 cases,and the masses were not reinforced.Three cases were scanned by MRI,and the ununion masses in area of adrenal gland were detected.There was iso signal in T1 weighted,while there was low signal in T2 weighted.Six cases underwent resection of adrenal gland; 5 cases underwent partial resection of adrenal gland and masses.The pathology of post operation were internal hemorrhage of adrenal gland medulla,and the hematoma was coated by the tissue of adrenal gland.The functions of adrenal cortex were all normal with follow up of 0.6 to 8 years. Conclusions The spontaneous adrenal hemorrhage can be diagnosed definitely by ultrasound B,CT and MRI.The symptoms of waist and abdominal pain were very distinctive with adrenal hemorrhage on both sides.The operation should be done when the adrenal hemorrhage is in one side and the hematoma exceeds 5 cm in diameter.Patrial resection of adrenal gland and hematoma should be operated for saving the normal adrenal tissues around the hematoma.