左肾上腺区特殊囊性占位病变的诊治——附胃重复囊肿二例报告  

Diagnosis and treatment of specially cystic lesion located at the area of the left adrenal gland ： 2 cases reports of adult gastric duplicated cyst

作　　者：王海涛[1] 张继伟[1] 阎乙夫[1] 夏溟[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院泌尿外科,100038

出　　处：《中华泌尿外科杂志》2012年第12期906-910,共5页Chinese Journal of Urology

摘　　要：目的探讨左侧肾上腺区特殊囊性占位病变的鉴别诊断，提高对胃重复囊肿临床病理特点及诊治的认识。方法2010年4月和2011年8月分别收治左侧肾上腺区特殊囊性占位病变1例，均为男性，年龄分别为28及42岁。患者均无特殊临床表现。超声及CT检查提示左肾上腺区囊肿，囊壁较厚且与胃大弯侧胃壁粘连。病变大小分别为5cm×6cm×7cm及8cm×12cm×13cm，囊内有分隔，动脉期无明显强化。术前诊断为左侧肾上腺区域囊性占位病变（肾上腺囊肿伴出血或感染）。2例均施行后腹腔镜下囊肿切除术。结合文献分析囊肿临床病理特征及影像学表现。结果2例手术顺利。术中明确囊肿紧邻左肾上腺且部分囊壁与胃大弯侧胃壁粘连紧密，但并不与胃腔相通。病理证实为胃重复囊肿。2例分别随访8个月及2年，左肾上腺区均未见囊肿复发，胃镜检查未见异常。结论成人胃重复囊肿临床罕见，术前确诊困难，超声及CT检查对定位、定性诊断具有一定价值；内镜超声及其引导下细针穿刺活检有望确诊。应纳入左侧肾上腺区囊性病变的鉴别诊断之列。本病有潜在恶变性，腹腔镜手术切除是主要的微创治疗方法。Objective To evaluate the differential diagnosis of specially cystic masses located at the area of the left adrenal gland, and to improve the understanding of the clinical symptoms and pathological features, diagnosis and treatment of gastric duplicated cyst. Methods A retrospective study, with litera- ture review, of clinical characteristics and imaging findings of pathologically proved gastric duplicated cyst in 2 adults （2 males, 28 years and 42 years）was conducted . Two patients presented no clinical manifestation. Abdominal uhrasonography and CT scan revealed a cystic lesion, in the area of the left adrenal gland, with a thickness wall, measuring 5 cm×6 cm ×7 cm and 8 cm ×12 cm × 13 cm, attached to the greater curvature of the stomach. The lesion had septums, and the walls and septums could not be enhanced. Preoperative di- agnosis of patients was misdiagnosed as a cyst of the left adrenal gland, with inflection or bleeding. Results Complete excision was performed by laparoscopic surgery in all cases. The lesion located in the ar- ea of left adrenal gland and no communication between the duplicated cyst and the lumen of stomach was de- tected. Postoperatively, the lesions were pathologically proved to be gastric duplicated cyst. There was no re- currence during the follow-up of 8 months and 2 years. Conclusions Preoperative definite diagnosis of a- dult gastric duplication cyst is very difficult. Ultrasonography and Computed Tomography are valuable ima- ging modality for locating the site and determining the nature of adult gastric duplicated cyst. Preoperative definite diagnosis could be made by EUS （endoscopic uhrasonography） and EUS-guided fine needle aspira- tion biopsy in gastric duplicated cyst. Although adult gastric duplicated cyst is an extremely rare disease enti- ty, but this unusual developmental abnormality should be include in the differential diagnosis of cystic mas-ses located the area of the left adrenal gland. Because of the possibility of malignancy of the cyst, laparo- scopic

关 键 词：胃重复囊肿 诊断 治疗 

分 类 号：R699[医药卫生—泌尿科学]