摘要
目的总结和提高原发性肾上腺皮质癌的诊治水平。方法回顾分析16例肾上腺皮质癌患者的临床资料。根据其临床症状、内分泌功能测定、影像学特点做出诊断，手术治疗并随访。结果16例患者中，内分泌功能紊乱者8例，以库欣征、性征异常、醛固酮增多症为主。超声、CT、MRI测定肿瘤直径为4．8～19．5cm，平均7．8cm。3例有远处转移。行根治性切除术13例，侵及同侧肾脏者做肾和肾上腙切除术2例，肾上腺肿瘤并腔静脉癌栓切除2例，腔静脉部分切除1例。病理结果：Ⅰ其耳2例，Ⅱ期8例，Ⅲ期3例，Ⅳ期3例。随访3-62个月，手术2年以上的11例患者中有6例仍存活，但1例肺转移，1例骨转移；死亡5例，平均存活26个月。结论肾上腺皮质癌患者预后差。影像学检查结合临床症状是早期诊断的关键，根治性手术是惟一有效的治疗方法。
Objective To improve the diagnosis and treatment of primary adrenocortical carcinoma. Methods Retrospective analysis was performed in clinical data of 16 patients with primary adrenoeortical carcinoma. The diagnosis was based on clinical presentations, hormonal studies and imaging. Surgical treatment was underwent on 13 cases. All patients were followed up for 3 to 62 months. Resuits Of 16 eases, functional tumors were in 8, including Cushing＇s syndrome in 5, combination of Cushing＇s syndrome and virilization in 2, and hyperaldosteronism in 1. Imaging studies revealed the tumors were 4.8 to 19.5 cm in diameter, average in 7.8 cm. Distant metastasis occurred in 3 cases. Radical surgery was done in 13 eases without distant metastasis, including radical adrenalectomy in 8, adrenalectomy plus nephrectomy in 2, adrenalectomy plus surgical extirpation of intracaval tumor thrombus in 2, and partial resection of the wall of inferior vena cava in 1. Pathologic stages were stage Ⅰ in 2 cases, stage Ⅱ in 8, stage Ⅲ in 3, stage Ⅳ in 3. Among the 11 eases who were treated over 2 years after operation, 6 cases were still survival, while 1 ease had pulmonary and 1 case had bone metastasis. The other 5 eases survive in average of 26 months. Conclusions Prognosis of primary adrenocortical carcinoma is poor. The keys to early diagnosis are clinical manifestations plus imaging. Surgical treatment is the only effective therapy for the disease.
出处
《中国医师进修杂志（外科版）》
2006年第1期16-18,共3页
Chinese Journal of Postgraduates of Medicine
关键词
肾上腺皮质肿瘤
癌
诊断
外科手术
Adrenocortical tumor, carcinoma
Diagnosis
Surgical treatment
