CAJ | 학술논문

目的：提高对肾上腺海绵状血管瘤的诊治水平。方法回顾性分析2013年6月18日收治的1例肾上腺海绵状血管瘤患者的资料，女，62岁。因阵发性血压升高10年，发现左肾上腺占位2个月入院。血压最高达175/55 mmHg（1 mmHg＝0．133 kPa），药物治疗效果不佳，近6个月血压控制不平稳。腹部超声检查示左侧肾上腺区低回声占位。腹部增强CT检查示左侧肾上腺前方不规则肿块，大小约4．5 cm×2．5 cm×3．9 cm，动脉期边缘强化，门脉期造影剂向内充填，延迟期为均匀高密度，考虑良性病变可能。腹部MR检查示腹主动脉左前方肿块，边缘清晰光滑，T1WI呈低信号， T2WI呈明显高信号，考虑嗜铬细胞瘤可能。24 h尿儿茶酚胺：去甲肾上腺素103．0 nmol，肾上腺素9．8 nmol，多巴胺18．9 nmol。奥曲肽显像检查：腹主动脉左前方生长抑素受体稍高表达。术前诊断为左肾上腺嗜铬细胞瘤。结果术前酚苄明药物准备3周，服药后血压维持在120～132/50～70 mmHg。患者鼻塞明显，手足皮温较高，体质量增加约1 kg。于全麻下行腹腔镜下左侧肾上腺肿瘤切除术，手术顺利，术后血压平稳，病理诊断为左肾上腺海绵状血管瘤。随访5个月，患者血压、心率平稳，无肿瘤复发。结论肾上腺海绵状血管瘤临床罕见，误诊率极高，对于影像学检查为典型血管瘤表现的肾上腺肿瘤，应考虑到本病的可能性。对于直径＞6 cm的肿瘤，建议手术，首选手术方式为腹腔镜下肾上腺肿瘤切除术，术中应尽量保留正常肾上腺组织。
목적：제고대신상선해면상혈관류적진치수평。방법회고성분석2013년6월18일수치적1례신상선해면상혈관류환자적자료，녀，62세。인진발성혈압승고10년，발현좌신상선점위2개월입원。혈압최고체175/55 mmHg（1 mmHg＝0．133 kPa），약물치료효과불가，근6개월혈압공제불평은。복부초성검사시좌측신상선구저회성점위。복부증강CT검사시좌측신상선전방불규칙종괴，대소약4．5 cm×2．5 cm×3．9 cm，동맥기변연강화，문맥기조영제향내충전，연지기위균균고밀도，고필량성병변가능。복부MR검사시복주동맥좌전방종괴，변연청석광활，T1WI정저신호， T2WI정명현고신호，고필기락세포류가능。24 h뇨인다분알：거갑신상선소103．0 nmol，신상선소9．8 nmol，다파알18．9 nmol。오곡태현상검사：복주동맥좌전방생장억소수체초고표체。술전진단위좌신상선기락세포류。결과술전분변명약물준비3주，복약후혈압유지재120～132/50～70 mmHg。환자비새명현，수족피온교고，체질량증가약1 kg。우전마하행복강경하좌측신상선종류절제술，수술순리，술후혈압평은，병리진단위좌신상선해면상혈관류。수방5개월，환자혈압、심솔평은，무종류복발。결론신상선해면상혈관류림상한견，오진솔겁고，대우영상학검사위전형혈관류표현적신상선종류，응고필도본병적가능성。대우직경＞6 cm적종류，건의수술，수선수술방식위복강경하신상선종류절제술，술중응진량보류정상신상선조직。
Objective To study the diagnosis and surgical treatment of adrenal cavernous hemangi -oma. Methods The data of one case with adrenal cavernous hemangioma was retrospectively reviewed .A 62-year-old female patient admitted in out hospital on 18th June, 2013 due to the paroxysmal hypertension for 10 years and finding the left adrenal mass for 2 months.Her highest blood pressure was 175/55 mmHg and the response for the drug treatment was poor .In recent 6 months, her blood pressure was unstable .Ab-dominal ultrasound showed a hypoechoic mass in left adrenal .Enhanced CT examination showed an irregular mass in the left adrenal gland , with the size of 4.5 cm ×2.5 cm ×3.9 cm,peripherally enhanced in arterial phase , contrast agent filling in portal venous phase , and high density in delay phase .Abdominal MR exami-nation showed a mass before abdominal aortic , with clear and smooth edge .The mass showed low signal in T1WI phase and high signal in T 2WI phase, which was considered as pheochromocytoma .24h urinary cate-cholamines showed that norepinephrine was 103.0 nmol, epinephrine was 9.8 nmol and dopamine was 18.9 nmol.Octreotide (99Tcm-TOC) showed slight high expression of somatostatin receptor .Preoperative diagnosis was left pheochromocytoma . Results After the preoperative medical preparation of phenoxybenzamine for 3 weeks, her blood pressure was maintained at 120-132/50-70 mmHg, with stuffy nose, warm hand and foot, and the weight gain of about 1 kg.The patient was undergone laparoscopic resection of left adrenal tumor under general anesthesia on June 24, 2013.The postoperative blood pressure returned to normal .And the left adrenal pathology was cavernous hemangioma .Following up for 5 months, the patient had normal blood pressure without the tumor recurrence . Conclusions The adrenal cavernous hemangioma is extreme-ly rare with high rate of misdiagnosis .For adrenal tumor with typical hemangioma imaging , the diagnosis of cavernous hemangioma should be considered .For tumors larger than 6 cm, surgery is recommended .The first choice of operative approach is laparoscopic resection of adrenal tumor , and normal adrenal tissue should be retained as far as possible.