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目的提高肾上腺皮质癌的诊断及治疗水平。方法回顾性统计肾上腺皮质癌24例,其中男15例,女9例,平均年龄54岁(22～96岁),无功能性肿瘤12例,功能性肿瘤12例,表现为Cushing综合征2例,表现为原发性醛固酮增多症1例,术前均行内分泌功能、超声及CT检查。结果 22例经手术治疗,完整肿瘤切除19例,另有3例因分别侵犯肝脏、胃壁及胰腺尾部难以彻底切除。术后病理Ⅰ期4例,Ⅱ期8例,Ⅲ期7例,Ⅳ期5例。随访3～70个月,平均生存23个月,9例存活至今。5例于术后局部复发,2例术后出现脑转移,3例肺转移,2例肝转移,给予联合化疗(顺铂+多柔比星+依托泊苷)后均未达到肿瘤缓解,术后平均生存13个月。结论肾上腺皮质癌恶性程度高、进展快、预后差、术后易复发,以根治性切除为主的综合治疗是治疗肾上腺皮质癌的有效方法。早期诊断和治疗可提高患者生存率。
Objective To improve the diagnosis and treatment of adrenocortical cancer. Methods Retrospective analysis of 24 cases of adrenocortical cancer, including 15 males and 9 females, mean age 54 years (22 to 96 years), 12 cases of non-functioning tumors, 12 cases of functional tumors, manifested as Cushing syndrome in 2 cases , Manifested as primary aldosteronism in 1 case, preoperative endocrine function, ultrasound and CT examination. Results Twenty-two cases were surgically treated, 19 cases had complete tumor resection, and 3 cases had incomplete resection of the liver, stomach wall and pancreas tail. Postoperative pathological stage Ⅰ in 4 cases, Ⅱ in 8 cases, Ⅲ in 7 cases, Ⅳ in 5 cases. All cases were followed up for 3 to 70 months, with an average survival of 23 months and 9 surviving to this day. Five patients had local recurrence after surgery, two had brain metastases after surgery, three had lung metastases, and two had liver metastases. All the patients had no tumor remission after combined chemotherapy (cisplatin + doxorubicin + etoposide) After an average survival of 13 months. Conclusion Adrenal cortical carcinoma has a high degree of malignancy, rapid progression, poor prognosis and easy recurrence after operation. Comprehensive treatment based on radical resection is an effective method for the treatment of adrenocortical carcinoma. Early diagnosis and treatment can improve patient survival.