中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2011年
36期
2561-2563
,共3页
黄钟明%李汉忠%肖河%纪志刚
黃鐘明%李漢忠%肖河%紀誌剛
황종명%리한충%초하%기지강
肾上腺肿瘤%节细胞神经瘤%诊断
腎上腺腫瘤%節細胞神經瘤%診斷
신상선종류%절세포신경류%진단
Adrenal neoplasms%Ganglioneuroma%Diagnosis
目的 探讨肾上腺节细胞神经瘤的临床表现、诊断与治疗。方法 分析1999至2010年在北京协和医院诊治的30例肾上腺节细胞瘤的影像学表现、实验室检查及相关临床资料，分析临床诊治的疗效与经验。结果 本组患者男12例，女18例，年龄7～63 (23.8±11.4)岁。肿瘤最大径2.5 ～15.0 cm。无临床症状，查体时偶然发现肾上腺区占位14例(46.7％)；因阵发心悸、头疼、头晕就诊7例，血压增高5例，腰腹痛4例。CT均表现低密度圆形或卵圆形肿物，9例(30.0％)肿物包绕周围血管生长，7例(23.3％)有散在点状或线状钙化；肿物CT值22 ～ 45（34.2±5.4）HU，增强后多呈进行性强化，延迟期CT值较平扫平均增高9.6 HU。24h尿儿茶酚胺和游离皮质醇在正常水平；7例患者行间碘苄胍显像（131I-MIBG显像）均为阴性，17例行生长抑素受体（奥曲肽）显像阴性15例(88.2％)，阳性2例(11.8％)。术前考虑本病诊断21例，术前发现骨转移1例。行开放手术11例，腹腔镜手术19例。随访1 ～11年，1例术前骨转移者病情进展，其余患者末见复发。结论 肾上腺节细胞神经瘤多为无特异性临床表现的良性病变，通过仔细询问病史，结合影像学及实验室检查，术前多数能准确诊断，手术切除总体预后良好。
目的 探討腎上腺節細胞神經瘤的臨床錶現、診斷與治療。方法 分析1999至2010年在北京協和醫院診治的30例腎上腺節細胞瘤的影像學錶現、實驗室檢查及相關臨床資料，分析臨床診治的療效與經驗。結果 本組患者男12例，女18例，年齡7～63 (23.8±11.4)歲。腫瘤最大徑2.5 ～15.0 cm。無臨床癥狀，查體時偶然髮現腎上腺區佔位14例(46.7％)；因陣髮心悸、頭疼、頭暈就診7例，血壓增高5例，腰腹痛4例。CT均錶現低密度圓形或卵圓形腫物，9例(30.0％)腫物包繞週圍血管生長，7例(23.3％)有散在點狀或線狀鈣化；腫物CT值22 ～ 45（34.2±5.4）HU，增彊後多呈進行性彊化，延遲期CT值較平掃平均增高9.6 HU。24h尿兒茶酚胺和遊離皮質醇在正常水平；7例患者行間碘芐胍顯像（131I-MIBG顯像）均為陰性，17例行生長抑素受體（奧麯肽）顯像陰性15例(88.2％)，暘性2例(11.8％)。術前攷慮本病診斷21例，術前髮現骨轉移1例。行開放手術11例，腹腔鏡手術19例。隨訪1 ～11年，1例術前骨轉移者病情進展，其餘患者末見複髮。結論 腎上腺節細胞神經瘤多為無特異性臨床錶現的良性病變，通過仔細詢問病史，結閤影像學及實驗室檢查，術前多數能準確診斷，手術切除總體預後良好。
목적 탐토신상선절세포신경류적림상표현、진단여치료。방법 분석1999지2010년재북경협화의원진치적30례신상선절세포류적영상학표현、실험실검사급상관림상자료，분석림상진치적료효여경험。결과 본조환자남12례，녀18례，년령7～63 (23.8±11.4)세。종류최대경2.5 ～15.0 cm。무림상증상，사체시우연발현신상선구점위14례(46.7％)；인진발심계、두동、두훈취진7례，혈압증고5례，요복통4례。CT균표현저밀도원형혹란원형종물，9례(30.0％)종물포요주위혈관생장，7례(23.3％)유산재점상혹선상개화；종물CT치22 ～ 45（34.2±5.4）HU，증강후다정진행성강화，연지기CT치교평소평균증고9.6 HU。24h뇨인다분알화유리피질순재정상수평；7례환자행간전변고현상（131I-MIBG현상）균위음성，17례행생장억소수체（오곡태）현상음성15례(88.2％)，양성2례(11.8％)。술전고필본병진단21례，술전발현골전이1례。행개방수술11례，복강경수술19례。수방1 ～11년，1례술전골전이자병정진전，기여환자말견복발。결론 신상선절세포신경류다위무특이성림상표현적량성병변，통과자세순문병사，결합영상학급실험실검사，술전다수능준학진단，수술절제총체예후량호。
ObjectiveTo evaluate the clinical characteristics, diagnosis and treatment for adrenal ganglioneuroma. MethodsThirty cases of adrenal ganglioneuroma at our hospital from 1999 to 2010 were reviewed. Their clinical, radiological, laboratory and pathologic findings as well as follow-up data were analyzed retrospectively. ResultsThere were 12 males and 18 females with an age range of 7 -63 (23.8 ±11.4) years old. Tumor size ranged from 2. 5 cm to 15 cm. Fourteen(46. 7％ )cases were found incidentally without any overt symptom. And the presenting symptoms and signs of the others were paroxysmal headache and palpitation (n = 7, 23.3％ ), hypertension ( n = 5, 16. 7％ ) and flank or abdominal pain ( n = 4,13. 3％ ). All cases underwent open or laproscopic operations and their diagnosis of adrenal ganglioneuroma was confirmed pathologically. An oval or crescentic well-defined mass, low or intermediate attenuation on CT (computed tomography) scan was found in most cases. Tumors partially or completely surrounded major blood vessels in 9 cases while 7 cases had discrete punctuate calcification. The 24-hours urinary catecholamine and urinary free cortisol output were within a normal range. Seventeen cases underwent a 99Tc-octreotide scan and negative results were found in 15 cases. Seven cases had a 131 I-Metaiodobenzylguanidine (131I-MIBG) scan and all results were negative. Twenty-one cases were diagnosed empirically as adrenal ganglioneuroma. One case was found pre-operatively with multiple bone metastases.Among all cases, either open operation (n = 11 ) or retroperitoneal laparoscopic excision ( n = 19 ) was performed successfully.All recovered smoothly. One patient with pre-operative bone metastasis developed progression. No recurrence was detected after a follow-up period of 1 - 11 years. ConclusionMostly benign in nature, adrenal ganglioneuromas is often found incidentally without specific clinic symptoms. A relatively accurate preoperative diagnosis can be made on the basis of a detailed history and the relevant imaging and laboratory results. Surgical resection of tumor is a preferred choice with a fairy good prognosis.
