Sakamoto Y, Kubota K, Mori M, Inoue K, Abe H, Harihara Y, Bandai Y, Makuuchi M
Second Department of Surgery, Faculty of Medicine, University of Tokyo, Japan.
Hepatogastroenterology. 1999 Mar-Apr;46(26):1036-41.
BACKGROUND/AIMS: Although the adrenal gland is one of the common sites for metastasis from hepatocellular carcinoma, the significance of adrenalectomy for treatment of metastatic hepatocellular carcinoma still remains unclear.
Analysis of 4 patients with adrenal metastasis from among 390 patients with hepatocellular carcinoma admitted to our department between October 1994 and December 1997, and a review of 79 cases reported between 1984 and 1997, were performed.
Four patients with adrenal metastasis, right in 2 and left in 2, underwent surgical treatment. Three of the patients developed tumor thrombi in the renal vein or inferior vena cava. Diagnosis of adrenal metastasis was made by ultrasonography or computed tomography scan, following an increase in serum tumor markers. Adrenalectomy with removal of the venous tumor thrombi was performed successfully. Three patients died of recurrence within 1 year, and one patient died due to other causes showing no recurrence at autopsy. The literature review revealed the left-sided metastases were significantly larger than the right-sided ones (p < 0.01). There was no significant difference in the survival periods between left and right metastasis, or between patients who underwent adrenalectomy and those treated by other means (p > 0.05).
The rationality of surgical treatment for adrenal metastasis from hepatocellular carcinoma still remains controversial. However, we believe that adrenalectomy would be a safe procedure and increases the chance of survival for patients.
背景/目的：尽管肾上腺是肝细胞癌常见的转移部位之一，但肾上腺切除术治疗转移性肝细胞癌的意义仍不明确。
分析了1994年10月至1997年12月间收治于我科的390例肝细胞癌患者中的4例肾上腺转移患者，并回顾了1984年至1997年间报道的79例病例。
4例肾上腺转移患者，2例为右侧转移，2例为左侧转移，均接受了手术治疗。其中3例患者肾静脉或下腔静脉出现瘤栓。在血清肿瘤标志物升高后，通过超声检查或计算机断层扫描确诊为肾上腺转移。成功实施了肾上腺切除术并切除了静脉瘤栓。3例患者在1年内死于复发，1例患者因其他原因死亡，尸检未发现复发。文献回顾显示左侧转移灶明显大于右侧转移灶（p < 0.01）。左右侧转移患者的生存期之间，以及接受肾上腺切除术的患者与接受其他治疗方法的患者之间，均无显著差异（p > 0.05）。
肝细胞癌肾上腺转移的手术治疗合理性仍存在争议。然而，我们认为肾上腺切除术是一种安全的手术，可增加患者的生存机会。
