肾上腺偶发瘤的外科治疗选择  

Rational choice of surgery for adrenal incidentaloma

作　　者：刘宇军[1] 张立[1] 孙立安[1] 林宗明[1] 许明[1] 朱同玉[1] 张永康[1] 王国民[1] 

机构地区：[1]复旦大学附属中山医院泌尿外科,上海200032

出　　处：《中华泌尿外科杂志》2010年第4期238-242,共5页Chinese Journal of Urology

摘　　要：目的探讨肾上腺偶发瘤的手术指征。方法总结147例肾上腺偶发瘤患者资料，分析偶发瘤的手术指征，比较腹腔镜和开放性手术的适应证。147例患者中，恶性肿瘤19例（12．9％），平均直径（8．5±3．9）cm，≤4cm者4例（21．1％），其中肾上腺皮质癌15例、恶性嗜铬细胞瘤4例；良性功能性肿瘤29例（19．7％），平均直径（4．1±2．1）cm，其中≥3cm者22例（75．9％）；19例良性嗜铬细胞瘤中24h尿香草扁桃酸升高2例，5例醛固酮瘤中血钾稍低2例，5例亚临床库欣综合征腺瘤患者血皮质醇升高，均无明显内分泌异常症状；良性无功能性肿瘤99例（67．3％），其中肾上腺皮质腺瘤61例（61．6％）。结果147例均行手术治疗。腹腔镜下手术组102例，开放性手术组45例，2组肿瘤直径分别为（3．4±1.8）cm和（6．7±1．5）cm（P〈0．0001）；手术并发症发生率分别为5．9％（6／102）和15．6％（7／45）（P=0．1103）。腹腔镜中转开放手术5例（4．9％），主要见于黏连严重的恶性肿瘤或肿瘤直径〉6cm者。结论肾上腺偶发瘤常见类型为无功能肾上腺腺瘤、嗜铬细胞瘤、肾上腺皮质癌。可疑恶性、有内分泌功能、直径≥3cm的肾上腺偶发瘤应积极手术治疗。腹腔镜手术创伤小、恢复快，为手术首选；肿瘤直径〉6cm、黏连严重、可疑恶性者应以开放性手术为主。Objective To discuss the indications of surgery for adrenal incidentaloma. Methods The clinical data of 147 cases of adrenal incidentaloma treated by surgery were reviewed. The indication of surgery was analyzed, and the differences between laparoscopic adrenalectomy and open adrenalectomy were discussed. Results Malignant tumor was identified in 12.9%（19/147）, including adrenocortical carcinoma in 15 cases, malignant pheochromocytoma in 4 cases. The mean diameter of these malignant tumor was （8. 5±3.9）cm,and 21.1 %（4/19）of them were 44 cm in diameter. Benign functional incidentaloma was found in 19.7%（29/147）, the mean diameter was（4.1 ±2.1）cm, and 75.9%（22/29）of them were ≥3 cm in diameter. Two of 19 cases of benign pheochromocytoma had increased 24 hour urine VMA, 2 of 5 cases of aldosterone-producing adenoma showed slightly decreased serum potassium, and 5 cases with subclinical Cushing syndrome had slight elevated plasma cortical steroid level. None of these functional incidentaloma had endocrinal symptom. Benign nonfunctional tumor was identified in 67.3 % （99/147）, and 61.6 % （61/99） of them were non-functional adrenal cortical adenoma. A total of 102 cases were performed laparoscopic adrenalectomy and 45 cases for open adrenalectomy. The tumor size of laparoscopy group was （3.4± 1.8）cm and（6.7±1.5）cm in open group（P〈0. 0001）. The overall morbidity rate was 5.9% （6/102） in former and 15.6% （7/45）in latter（P= 0. 1103）. Laparoscopic adrenalectomies succeeded in 97 cases, while conversion to open procedure in 5 cases （4.9%）, most of them were malignant, adhesive, or 〉6 cm in diameter. Conclusions Non-functional adrenal cortical adenoma, pheochromocytoma and adrenocortical carcinoma were the most common adrenal incidentaloma. Surgery should be considered in all patients with malignancy suspicious, clinical or biochemical evidence of functional tumor, and those of ≥3 cm in diameter. Laparoscopy is safe and effective in treatment of incident

关 键 词：肾上腺肿瘤 外科手术 选择性 

分 类 号：R736.6[医药卫生—肿瘤]