CAJ | 학술논문

目的探讨左侧肾上腺区特殊囊性占位病变的鉴别诊断,提高对胃重复囊肿临床病理特点及诊治的认识. 方法 2010年4月和2011年8月分别收治左侧肾上腺区特殊囊性占位病变1例,均为男性,年龄分别为28及42岁.患者均无特殊临床表现.超声及CT检查提示左肾上腺区囊肿,囊壁较厚且与胃大弯侧胃壁粘连.病变大小分别为5 cm×6 cm×7 cm及8 cm×12 cm×13 cm,囊内有分隔,动脉期无明显强化.术前诊断为左侧肾上腺区域囊性占位病变(肾上腺囊肿伴出血或感染).2例均施行后腹腔镜下囊肿切除术.结合文献分析囊肿临床病理特征及影像学表现.结果2例手术顺利.术中明确囊肿紧邻左肾上腺且部分囊壁与胃大弯侧胃壁粘连紧密,但并不与胃腔相通.病理证实为胃重复囊肿.2例分别随访8个月及2年,左肾上腺区均未见囊肿复发,胃镜检查未见异常. 结论成人胃重复囊肿临床罕见,术前确诊困难,超声及CT检查对定位、定性诊断具有一定价值；内镜超声及其引导下细针穿刺活检有望确诊.应纳入左侧肾上腺区囊性病变的鉴别诊断之列.本病有潜在恶变性,腹腔镜手术切除是主要的微创治疗方法.
목적 탐토좌측신상선구특수낭성점위병변적감별진단,제고대위중복낭종림상병리특점급진치적인식. 방법 2010년4월화2011년8월분별수치좌측신상선구특수낭성점위병변1례,균위남성,년령분별위28급42세.환자균무특수림상표현.초성급CT검사제시좌신상선구낭종,낭벽교후차여위대만측위벽점련.병변대소분별위5 cm×6 cm×7 cm급8 cm×12 cm×13 cm,낭내유분격,동맥기무명현강화.술전진단위좌측신상선구역낭성점위병변(신상선낭종반출혈혹감염).2례균시행후복강경하낭종절제술.결합문헌분석낭종림상병리특정급영상학표현.결과2례수술순리.술중명학낭종긴린좌신상선차부분낭벽여위대만측위벽점련긴밀,단병불여위강상통.병리증실위위중복낭종.2례분별수방8개월급2년,좌신상선구균미견낭종복발,위경검사미견이상. 결론 성인위중복낭종림상한견,술전학진곤난,초성급CT검사대정위、정성진단구유일정개치；내경초성급기인도하세침천자활검유망학진.응납입좌측신상선구낭성병변적감별진단지렬.본병유잠재악변성,복강경수술절제시주요적미창치료방법.
Objective To evaluate thedifferential diagnosis of specially cystic masses located at the area of the left adrenal gland,and to improve the understanding of the clinical symptoms and pathological features,diagnosis and treatment of gastric duplicated cyst.Methods A retrospective study,with literature review,of clinical characteristics and imaging findings of pathologically proved gastric duplicated cyst in 2 adults (2 males,28 years and 42 years)was conducted.Two patients presented no clinical manifestation.Abdominal ultrasonography and CT scan revealed a cystic lesion,in the area of the left adrenal gland,with a thickness wall,measuring 5 cm ×6 cm× 7 cm and 8 cm × 12 cm × 13 cm,attached to the greater curvature of the stomach.The lesion had septums,and the walls and septums could not be enhanced.Preoperative diagnosis of patients was misdiagnosed as a cyst of the left adrenal gland,with inflection or bleeding.Results Complete excision was performed by laparoscopic surgery in all cases.The lesion located in the area of left adrenal gland and no communication between the duplicated cyst and the lumen of stomach was detected.Postoperatively,the lesions were pathologically proved to be gastric duplicated cyst.There was no recurrence during the follow-up of 8 months and 2 years.Conclusions Preoperative definite diagnosis of adult gastric duplication cyst is very difficult.Ultrasonography and Computed Tomography are valuable imaging modality for locating the site and determining the nature of adult gastric duplicated cyst.Preoperative definite diagnosis could be made by EUS (endoscopic ultrasonography) and EUS-guided fine needle aspiration biopsy in gastric duplicated cyst.Although adult gastric duplicated cyst is an extremely rare disease entity,but this unusual developmental abnormality should be include in the differential diagnosis of cystic masses located the area of the left adrenal gland.Because of the possibility of malignancy of the cyst,laparoscopic excision is the first choice as the minimally invasive treatment.