CAJ | 학술논문

目的：回顾近10年间我们诊治的产前B超发现的26例肾上腺肿块患儿临床资料，探讨B超检查发现胎儿肾上腺肿块的诊断和治疗。方法2003年6月至2012年12月本院收治经产前B超发现的新生儿肾上腺肿块26例，均进行了手术治疗，对该组病例进行回顾性分析和随访。结果肾上腺肿块患儿26例；男16例，女10例；所有病例均进行了肿瘤肉眼完整切除＋后腹膜肿大淋巴结清扫手术（其中1例因肿瘤浸润同侧肾脏而行肿瘤及受累肾脏一并切除术）。术后病理证实为肾上腺神经母细胞瘤17例，肾上腺血肿5例，海绵状血管瘤2例，成熟畸胎瘤和嗜铬细胞瘤各1例。神经母细胞瘤组与非神经母细胞瘤组在肿块大小（P＝0.04，P＜0.05），B 超肿块内有血流信号（P＝0.03，P＜0.05）、增强CT肿块内有强化（P＝0.01，P＜0.05）上比较，差异有统计学意义。在巨大儿所占该组比例（体重＞4 kg）（P＝0.363）、随机尿VMA/Crea 检查（P＝0.389）两个方面比较，差异无统计学意义。结论通过评估肿块大小、肿块内血流信号（B超）和肿块内有强化（增强CT）等即可对神经母细胞瘤做出较为准确的诊断。而出生体重和随机尿VMA/Crea在鉴别诊断中意义不大。较大的新生儿肾上腺实质性肿块多数为肿瘤，如神经母细胞瘤等，建议出生后尽早手术，如果手术切除彻底则术后可不必化疗；较小的囊性肿块可能为肾上腺血肿，出生后血肿可变小或者消失。4s期神经母细胞瘤建议进行术后化疗，通常新生儿时期化疗耐受性较差，通常预后不佳。
목적：회고근10년간아문진치적산전B초발현적26례신상선종괴환인림상자료，탐토B초검사발현태인신상선종괴적진단화치료。방법2003년6월지2012년12월본원수치경산전B초발현적신생인신상선종괴26례，균진행료수술치료，대해조병례진행회고성분석화수방。결과신상선종괴환인26례；남16례，녀10례；소유병례균진행료종류육안완정절제＋후복막종대림파결청소수술（기중1례인종류침윤동측신장이행종류급수루신장일병절제술）。술후병리증실위신상선신경모세포류17례，신상선혈종5례，해면상혈관류2례，성숙기태류화기락세포류각1례。신경모세포류조여비신경모세포류조재종괴대소（P＝0.04，P＜0.05），B 초종괴내유혈류신호（P＝0.03，P＜0.05）、증강CT종괴내유강화（P＝0.01，P＜0.05）상비교，차이유통계학의의。재거대인소점해조비례（체중＞4 kg）（P＝0.363）、수궤뇨VMA/Crea 검사（P＝0.389）량개방면비교，차이무통계학의의。결론통과평고종괴대소、종괴내혈류신호（B초）화종괴내유강화（증강CT）등즉가대신경모세포류주출교위준학적진단。이출생체중화수궤뇨VMA/Crea재감별진단중의의불대。교대적신생인신상선실질성종괴다수위종류，여신경모세포류등，건의출생후진조수술，여과수술절제철저칙술후가불필화료；교소적낭성종괴가능위신상선혈종，출생후혈종가변소혹자소실。4s기신경모세포류건의진행술후화료，통상신생인시기화료내수성교차，통상예후불가。
Objetive This paper reviewed 26 cases of adrenal masses found by prenatal B ultrasound in infants in our hospital in recent 1 0 years. Methods 26 cases of neonatal adrenal masses between 2003 June and 201 2 December underwent operation in Shanghai Children's Medical Center. Gender,Birth weight,Ran-dom urine VMA/Crea,mass location,size,results of B ultrasound and contrast CT of these infants were ana-lyzed. Results 26 cases had adrenal masses;male 1 6 cases,female 1 0 cases. All patients were tumor exci-sion,retroperitoneal lymph node exploration and dissection (renal resection was performed in one case because of the right adrenal tumor infiltrating ipsilateral renal). Postoperative pathology showed adrenal neuroblastoma (NB)in 1 7 cases,5 cases of adrenal hematoma,2 cases of cavernous hemangioma,1 cases of mature terato-ma,1 cases of pheochromocytoma. Significant statistically difference were found in tumor size (P=0.04,P<0.05),blood flow signal with B ultrasound (P=0.03,P<0.05),and mass enhancement in contrast CT scan (P=0.01 ,P<0.05 )between NB and non NB groups. The proportion of the macrosomia (body weight,>4 kg,P=0.363 )and VMA/Crea of random urine (P=0.389 )had no statistically significant differences be-tween NB and non NB groups. Conclusion Comparatively accurate diagnosis of neuroblastoma should be ob-tained through the assessment of tumor size,blood flow signal (B ultrasound)and enhanced in the mass (Con-trast CT). And the birth weight and urinary VMA/Crea is not useful in the differential diagnosis. Most of the larger neonatal adrenal masses may be tumors,such as neuroblastoma,should be cured after birth as soon as possible. Small cystic mass may be adrenal hematomas and most of them may disappear after birth.Most of neo-natal adrenal neuroblastoma can be cured with only operation,no need chemotherapy after operation,so the op-erations should be thorough resection that is the key to guarantee the efficacy. The tolerance to chemotherapy is poor in neonates,and it is usually associated with poor prognosis.