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目的:探讨肾上腺恶性肿瘤的诊断和治疗方法。方法:回顾性分析34例肾上腺恶性肿瘤的临床资料。其中肾上腺皮质癌13例;恶性嗜铬细胞瘤8例;肾上腺转移癌8例;皮质癌并发同侧肾盂癌1例;节神经母细胞瘤1例;恶性纤维组织瘤1例;脂肪肉瘤1例;肾上腺髓外浆细胞瘤1例。全部34例患者中,有临床症状者23例,有内分泌功能改变者22例。结果:所有患者均接受手术治疗,其中29例肿瘤全切,4例肿瘤小部分或包膜残留,1例仅探查取活检。32例获得随访,时间为2个月～5年。死亡11例,死亡患者生存期为5～29个月,平均21个月。结论:对于肾上腺恶性肿瘤患者,手术切除是首选治疗方法,并且术后的随访很重要。肾上腺皮质癌患者总体预后较差,化疗和放疗可作为术后辅助治疗。恶性嗜铬细胞瘤患者预后较好,MIBG和酚苄明可改善患者生存。对于转移性肾上腺肿瘤患者,手术切除孤立的转移灶可明显提高患者的5年生存率。
Objective: To investigate the diagnosis and treatment of adrenal malignancies. Methods: The clinical data of 34 adrenal malignancies were retrospectively analyzed. Including 13 cases of adrenocortical carcinoma, 8 cases of malignant pheochromocytoma, 8 cases of adrenal metastasis, 1 case of cortical carcinoma with ipsilateral renal pelvis carcinoma, 1 case of neuroblastoma, 1 case of malignant fibrous tissue tumor, 1 case of liposarcoma ; Adrenal plasmacytoma in 1 case. Of the 34 patients, 23 had clinical symptoms and 22 had changes in endocrine function. Results: All the patients underwent surgical treatment. Totally 29 patients had complete resection of the tumor, 4 had a small part of the tumor or remained in the capsule, and 1 patient had only biopsy. 32 cases were followed up for 2 months to 5 years. Eleven patients died, the survival of patients died of 5 to 29 months, an average of 21 months. CONCLUSIONS: Surgical resection is the preferred treatment for patients with adrenal malignancies and postoperative follow-up is important. The overall prognosis of patients with adrenal cortical cancer is poor, chemotherapy and radiotherapy can be used as adjuvant therapy. Malignant pheochromocytoma patients with good prognosis, MIBG and phenoxybenzamine can improve patient survival. For patients with metastatic adrenal tumors, surgical removal of isolated metastases can significantly improve the 5-year survival rate of patients.