肾上腺皮质癌的诊断与治疗(附33例报告)  

Diagnosis and treatment of adrenocortical carcinoma(Report of 33 cases)

作　　者：熊思清[1,2] 陈丽平[1,2] 杨绍波[1] 孔垂泽[1] 

机构地区：[1]中国医科大学附属第一医院泌尿外科,沈阳110001 [2]江西省吉安市中心人民医院

出　　处：《临床泌尿外科杂志》2012年第6期421-424,共4页Journal of Clinical Urology

摘　　要：目的:提高对肾上腺皮质癌的认识及诊治水平。方法:回顾性分析1983～2010年经病理检查确诊的33例肾上腺皮质癌患者的临床资料:有内分泌功能紊乱者15例,主要表现为库欣综合征,性征异常及原发性醛固酮增多症相对少见;无内分泌功能紊乱者18例,主要表现为腹部肿块、腰腹部不适或疼痛等,CT及MRI多提示肿瘤体积较大,内部密度不均匀,边界不规则,常伴坏死或出血,偶伴钙化。33例均经手术及病理检查确诊。结果:术中下腔静脉破裂出血而死亡1例,肿瘤完整切除者24例,姑息性切除者8例。按ENSAT临床分期:Ⅰ期3例,平均存活49个月,5年存活1例;Ⅱ期12例,平均存活32个月;Ⅲ期10例,平均存活14个月;Ⅳ期8例,平均存活6个月。15例分别于术后4～37个月出现局部复发或远处转移,其中11例复发于2年内。结论:肾上腺皮质癌临床罕见,恶性度高,预后差,复发率高。手术是唯一有效的治疗方法,术后辅以放化疗有助于提高疗效。加强术后随访对早期发现肿瘤复发及早期治疗具有重要意义。Objective： To improve the diagnosis and treatments of adrenocortical carcinoma（ACC）. Methods： The clinical data of 33 patients with ACC were reviewed： In 15 patients, the tumor was functional, the other 18 was nonfunctional. The functional ACC mainly showed Cushing＇s syndrome. The nonfunctional had no specific symptoms such as back pain, abdominal mass and discomfort. CT and MRI typically demonstrated irregular boundary and uneven density of the tumor. Constantly, necrosis and bleeding can be seen in the tumor. All the pa- tients treated by surgery and confirmed by pathology exams. Results： One case died of the rupture of inferior vena eava. 24 cases underwent complete resection and 8 incomplete resection. The tumor was ENSAT stage I in 3, the median survival time being 49 months and the 5-year survival in one. The tumor was stage Ⅱ in 12, the median survival time being 32 months. 10 were stage Ⅲ , the median survival time being 14 months. 8 were stage IV, the median survival time being 6 months. 15 patients had recurrence after operation between 4 and 37 months, and 11 within 2 years. Conclusions： ACC is a rare heterogeneous malignancy with poor prognosis and high recurrence rates. Surgical resection of the tumor is the only potentially curative treatment, and postoperative chemotherapy and radiotherapy may improve the outcome. Close follow-up is important for detecting recurrence at an early stage, especially in the first 2 years.

关 键 词：肾上腺皮质肿瘤 诊断 治疗 

分 类 号：R736.6[医药卫生—肿瘤]