论文部分内容阅读
目的:提高皮质醇增多症的治疗水平。方法:总结90例皮质醇增多症的临床资料以及随访情况。90例患者均有库欣综合征的临床表现,内分泌检查提示高皮质醇状态。71例患者影像学检查发现肾上腺肿块,其中左侧32例,右侧34例;双侧肾上腺肿块5例。19例患者显示双侧肾上腺结节样增生。结果:90例患者均行肾上腺手术,其中60例行肾上腺肿块切除加同侧肾上腺部分切除;6例行肾上腺肿块切除加同侧肾上腺全切除;4例行同时行双侧肾上腺全切除术,6例行先后双侧肾上腺全切除术;11例行单侧肾上腺全切除术;3例行先后双侧肾上腺次全切除。病理显示6例原发性色素性皮质结节状肾上腺皮质增生(PPNAD);5例大结节样肾上腺皮质增生(AIMAH);57例肾上腺皮质腺瘤;5例肾上腺皮质癌;17例肾上腺皮质结节样增生,其中7例考虑异位ACTH综合征所致。结论:肾上腺皮质腺瘤切除术效果最好,库欣症状改善最显著。迁延难愈的库欣病,单侧肾上腺全切除,在短期内能缓解代谢症状。分时分侧行肾上腺全切除术,对治疗AIMAH和PPNAD更安全、稳定;根据异位ACTH综合征患者症状和病程,可同时行双侧肾上腺全切除或单侧肾上腺全切除。
Objective: To improve the treatment of Cushing’s disease. Methods: The clinical data and follow-up of 90 patients with cortisol hypersecretion were summarized. 90 patients had clinical manifestations of Cushing’s syndrome, endocrine examination prompted high cortisol status. Radiologic examination of 71 patients revealed adrenal masses, including 32 on the left and 34 on the right, and 5 on both adrenal masses. Nineteen patients showed bilateral adrenal nodular hyperplasia. Results: All the 90 patients underwent adrenalectomy, in which 60 cases underwent adrenalectomy plus ipsilateral adrenalectomy; 6 cases underwent adrenalectomy plus ipsilateral adrenalectomy; 4 cases underwent simultaneous bilateral adrenalectomy, 6 Routine bilateral total adrenalectomy; 11 cases of unilateral adrenalectomy; 3 cases of bilateral adrenal subtotal resection. Pathology showed 6 cases of primary pigmented cortical nodular adrenal hyperplasia (PPNAD); 5 cases of large nodular adrenal hyperplasia (AIMAH); 57 cases of adrenal cortical adenoma; 5 cases of adrenal cortical carcinoma; 17 cases of adrenal cortex Nodular hyperplasia, of which 7 cases due to ectopic ACTH syndrome. Conclusion: The best effect of adrenocortical adenoma resection, Cushing symptom improvement the most significant. Retain the Cushing’s disease, unilateral adrenalectomy, in the short term can relieve metabolic symptoms. Subtotal adrenalectomy is more safe and stable in treating AIMAH and PPNAD. According to the symptoms and course of ectopic ACTH syndrome, bilateral total adrenalectomy or unilateral adrenalectomy can be performed simultaneously.