Wunderlich H, Schubert J
Universitätsklinik und -polikllnik für Urologie der Friedrich-Schiller-Universität Jena.
Z Arztl Fortbild (Jena). 1996 May;90(3):221-6.
Innovations in diagnosis and therapy of adrenal neoplasms require a discussion about these tumors. Especially, the articles deal with the radiologic evaluation of the adrenal gland, technical as well as perioperative considerations of adrenalectomy, and adrenocortical carcinoma. Several conclusions can be drawn from our own results and a review of the literature. Firstly, the diagnostic accuracy should improve with advances in magnetic resonance imaging. Secondly, all asymptomatic nonfunctional adrenal masses about 3 cm require removal. Thirdly, adrenocortical carcinomas are generally curable only if small and localized. Fourthly, among the adrenal tumors, pheochromocytomas--especially malignant pheochromocytomas--deserve a careful approach: adequate preparation and early ligation of the adrenal vein after transabdominal access are the main goals. Finally, adjuvant treatment regimens for more advanced adrenocortical carcinomas using mitotane and conventional multiagent chemotherapy need to be evaluated in randomized trials.
肾上腺肿瘤诊断与治疗的创新需要对这些肿瘤进行讨论。特别是，这些文章涉及肾上腺的放射学评估、肾上腺切除术的技术及围手术期注意事项，以及肾上腺皮质癌。从我们自己的结果和文献综述中可以得出几个结论。首先，随着磁共振成像技术的进步，诊断准确性应有所提高。其次，所有直径约3厘米的无症状无功能肾上腺肿块均需切除。第三，肾上腺皮质癌一般只有在肿瘤较小且局限时才可治愈。第四，在肾上腺肿瘤中，嗜铬细胞瘤——尤其是恶性嗜铬细胞瘤——需要谨慎处理：充分的准备以及经腹入路后早期结扎肾上腺静脉是主要目标。最后，需要通过随机试验评估使用米托坦和传统多药化疗对更晚期肾上腺皮质癌的辅助治疗方案。
