Breza J, Zvara V, Kreze A, Balazovjech I, Pauer M
Clinique Urologique, Comenius University, Bratislava, Slovaquie.
Ann Urol (Paris). 1996;30(1):26-32.
The authors report their experience of 34 benign and 17 malignant tumours of the adrenal cortex. Both occurred more frequently in women (79.4% of cortical adenomas and 70.6% of adrenocortical carcinomas). Moreover, females were significantly younger (average age: adenomas: females 44.9 years and males 54.4 years, adrenocortical carcinomas: females 34.1 years and males 58.3 years). Some tumours presented in the form of increased hormone production, while others were hormonally inactive and did not cause clinical signs until later. Pain was the first symptom in the cases of malignant adrenocortical tumours. Adenomas occurred as frequently twice in the left adrenal gland (24 versus 12), whereas carcinomas were more than twice are frequent on the right (10 versus 7). Ultrasonography and CT were appropriate and fully sufficient methods for the diagnosis of adrenal tumours. Arteriography was valuable in the differential diagnosis of large upper abdominal masses when the organ of origin could not be identified by CT and for determination of anatomic conditions and subsequent surgical tactics. For small tumours of the adrenal cortex, the classic lumbar approach through the bed of the resected eleventh rib is adequate. For larger tumours, extended lumbotomy, laparotomy or thoracotomy is necessary.
作者报告了他们对34例肾上腺皮质良性肿瘤和17例恶性肿瘤的治疗经验。两者在女性中更为常见（皮质腺瘤中女性占79.4%，肾上腺皮质癌中女性占70.6%）。此外，女性患者明显更年轻（平均年龄：腺瘤：女性44.9岁，男性54.4岁；肾上腺皮质癌：女性34.1岁，男性58.3岁）。一些肿瘤表现为激素分泌增加，而另一些则无激素活性，直到后期才出现临床症状。疼痛是恶性肾上腺皮质肿瘤患者的首发症状。腺瘤在左肾上腺的发生率是右肾上腺的两倍（24例对12例），而癌在右肾上腺的发生率是左肾上腺的两倍多（10例对7例）。超声检查和CT是诊断肾上腺肿瘤合适且充分的方法。当CT无法确定上腹部较大肿块的起源器官时，动脉造影对鉴别诊断有价值，并且有助于确定解剖情况及后续手术策略。对于肾上腺皮质小肿瘤，经切除第11肋床的经典腰部入路即可。对于较大的肿瘤，则需要扩大腰部切口、剖腹手术或开胸手术。
