双侧孤立性肾上腺肿瘤引起的库欣综合征的临床诊治分析  

Diagnosis and treatment of Cushing＆#39;s syndrome caused by bilateral solitary adrenal neoplasma

作　　者：成康[1] 周薇薇[2] 黄宝星[1] 曹万里[1] 宿恒川[1] 余忠伟[1] 孙福康[1] 王卫庆[2] 

机构地区：[1]上海交通大学医学院附属瑞金医院泌尿外科,200025 [2]上海交通大学医学院附属瑞金医院内分泌科,200025

出　　处：《中华内分泌代谢杂志》2016年第6期494-498,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：上海市教委科研创新项目（14YZ050）

摘　　要：目的评估单侧肾上腺肿瘤切除加同侧肾上腺大部切除术对于治疗双侧孤立性肾上腺肿瘤所致库欣综合征的效果,并探讨其治疗原则。方法2007年至2013年,共有10例患者被诊断为双侧孤立性肾上腺肿瘤引起的库欣综合征。对比分析患者术前和术后的临床症状、激素水平、生化和代谢参数以及影像数据的变化。5例患者根据双侧肾上腺静脉采血的结果,选择优势分泌侧进行手术切除。5例患者根据计算机断层扫描结果直接选择直径大者进行切除手术。结果单侧肾上腺肿瘤切除加同侧肾上腺大部切除术术后,24 h尿皮质醇显著降低（P〈0.05）,午夜血皮质醇水平显著降低（P〈0.01）。血促肾上腺皮质激素水平显著增加（P〈0.01）。9例患者不再需要接受对侧手术,1例患者因为库欣综合征症状未得到缓解而在5个月后接受了对侧肾上腺肿瘤切除术。结论单侧肾上腺肿瘤切除加同侧肾上腺大部切除术对于治疗由双侧孤立性肾上腺肿瘤所致库欣综合征是一个有效且安全的方法。Objective To evaluate the efficacy of unilateral subtotal adrenalectomy in the treatment of bilateral adrenal solitary neoplasma causing Cushing＆#39;s syndrome and to elaborate the therapeutic principle. Methods From 2007 to 2013, a total of ten patients were diagnosed with Cushing＆#39;s syndrome caused by bilateral solitary adrenal neoplasma. We compared patients＆#39;clinical symptoms, hormone profiles, biochemical and metabolic parameters, and imaging data before and after the surgery. Five of them chose the optimal neoplasma based on the lateralization ratio of adrenal venous sampling result and the other 5 patients chose the optimal neoplasma based on the diameter of the mass reflected by the computed tomography result and were then operated. Results After the unilateral subtotal adrenalectomy,the24-hour urinary free cortisol decreased significantly（P〈0.05）and the midnight serum cortisol level also significantly reduced（P〈0. 01）. Plasma adrenocorticotropic hormone level increased significantly（P〈0. 01）. Nine patients of them did not need contralateral adrenalectomy and one patient received contralateral adrelectomy because of the remnant of Cushingnoid symptoms. Conclusion Unilateral subtotal adrenalectomy is an effective and safe way to treat Cushing＆#39;s syndrome caused by bilateral solitary neoplasma.

关 键 词：双侧肾上腺静脉采血 单侧肾上腺手术 双侧肾上腺肿瘤 库欣综合征 

分 类 号：R736.6[医药卫生—肿瘤] R586.2[医药卫生—临床医学]