University of Michigan Health System, 1500 East Medical Center Drive, 2920F Taubman Center, Ann Arbor, MI 48109-5331, USA.
Department of Surgery, Boston University, 75 East Newton Street, Boston, MA 02118, USA.
Nat Rev Endocrinol. 2014 May;10(5):282-92. doi: 10.1038/nrendo.2014.26. Epub 2014 Mar 18.
The surgical treatment of adrenal tumours has evolved over the past century, as has our understanding of which hormones are secreted by the adrenal glands and what these hormones do. This article reviews the preoperative evaluation of patients with adrenal tumours that could be benign or malignant, including metastases. The biochemical evaluation of excess levels of hormones is discussed, as are imaging characteristics that differentiate benign tumours from malignant tumours. The options for surgical management are outlined, including the advantages and disadvantages of various open and laparoscopic approaches. The surgical management of adrenocortical carcinoma is specifically reviewed, including controversies in operative approaches as well as surgical management of invasive or recurrent disease.
过去一个世纪以来，肾上腺肿瘤的外科治疗一直在发展，我们对肾上腺分泌的激素以及这些激素的作用的认识也在不断提高。本文回顾了可良、恶性（包括转移灶）的肾上腺肿瘤患者的术前评估。讨论了激素水平升高的生化评估，以及有助于区分良、恶性肿瘤的影像学特征。概述了手术治疗的选择，包括各种开放和腹腔镜方法的优缺点。特别回顾了肾上腺皮质癌的手术治疗，包括手术入路的争议以及侵袭性或复发性疾病的手术处理。
