肾上腺皮质黑色腺瘤的诊断与治疗(附7例报告)  

Diagnosis and Treatment of Adrenal Black Adenoma: Report of 7 Cases

作　　者：薛永平[1] 胡卫列[1] 

机构地区：[1]第二军医大学广州临床医学院广州军区广州总医院泌尿外科,广州510010

出　　处：《中国微创外科杂志》2016年第7期617-620,631,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的：探讨肾上腺皮质黑色腺瘤的临床特点、病理特征及诊治方法。方法2002年6月～2014年7月对7例肾上腺皮质黑色腺瘤行后腹腔镜下肾上腺肿瘤切除术，健侧卧位，腋后线第12肋缘下、腋中线髂棘上2 cm、腋前线12肋缘下共3个trocar穿刺入路，自制球囊扩张器建立后腹膜腔，超声刀将肿瘤完整切除。结果7例肿瘤后腹腔镜下被完整切除，平均手术时间60 min（34～90 min），术中平均出血量70 ml（20～200 ml），均未输血。术后3～4 d拔除后腹腔引流管，6～7 d出院。病理结果均为肾上腺皮质黑色腺瘤。2例表现为Cushing 综合征、3例表现为高血压均于术后恢复正常。7例随访12～24个月，平均18个月，无复发和转移。结论肾上腺皮质黑色腺瘤是肾上腺皮质腺瘤的一种少见类型，无典型的临床表现，需要经病理检查明确诊断，后腹腔镜下切除肾上腺皮质黑色腺瘤微创、安全、有效，值得临床推广应用。Objective To explore the diagnosis and treatment of adrenal black adenoma . Methods From June 2002 to July 2014, 7 patients with adrenal tumors were treated with retroperitoneal laparoscopic partial adrenalectomy in our hospital .During the operation all the patients were placed in healthy lateral decubitus position .Three trocars were introduced into the lumbar region：below the 12th rib along the anterior and posterior axillary lines , and 2 cm beyond superior iliac spine on the middle axillary line .The retroperitoneal space was established with homemade balloon-expanding devices .Afterwards , the tumors were removed by using a harmonic scalpel. Results All the tumors were resected completely .The average operation time was 60 min （range, 34-90 min） and the average blood loss in the operation was 70 ml （range, 20 -200 ml） without blood transfusion.The drainage tubes were removed on the 3rd or 4th postoperative day and the patients were discharged on the 6th or 7th postoperative day .They were pathologically diagnosed as adrenal black adenoma . Two patients manifested the Cushing ’ s syndrome and 3 patients showed hypertension , all of which were recovered to normal postoperatively .No recurrence or metastasis was noted during a follow-up for 12-24 months （mean, 18 months）. Conclusions Adrenal black adenoma, without specific clinical features, is a rare kind of adrenocortical adenoma .The confirmative diagnosis depends on pathological results .Retroperitoneal laparoscopic surgery is a minimally invasive, safe and effective technique for adrenal black adenoma , which provides favorable prognosis .

关 键 词：肾上腺皮质腺瘤 肾上腺皮质黑色腺瘤 后腹腔镜 

分 类 号：R736.6[医药卫生—肿瘤]