Clinical analysis of 155 adrenal cyst cases

Transcription

1 January 2012 Vol. 32 No CT 92. 2% 櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐 * ~ ~ 11 cm 2. 6 cm CT 92. 2% MRI 86. 4% B 61. 0% min 2. 2 d min 8. 6 d 86 / /156 3 /156 1 ~ 16 1 CT 5cm A Clinical analysis of 155 adrenal cyst cases WANG Dong LI Han-zhong * SHI Bing-bing Dept. of Urology PUMC Hospital PUMC & CAMS Beijing China Abstract Objective To optimize the diagnosis and treatment for adrenal cysts and to evaluate the safety and efficacy of laparoscopic surgery for adrenal cysts. Methods One hundred and fifty-five patients with adrenal cysts underwent surgery in Peking Union Medical College Hospital. The preoperative symptoms preoperative diagnosis treatments intra-and postoperative complications subclassification of adrenal cysts by Histology and follow-up in * corresponding author lihanzhong@ medial. com. cn

2 patients after surgery were reviewed respectively. Results We identified 155 patients who underwent surgery for adrenal cysts. The median age was 43 years. 154 adrenal cysts were unilateral and 1 case was bilateral. The diameter was 2. 6 cm on average ranging from 2 to 11cm. The accuracy of diagnosis of CT MRI and B-us was 92. 2% 86. 4% 61. 0% respectively. By endocrinology test 2 cases were diagnosed as primary aldosteronism 2 cases as pheochromocytoma. 146 laparoscopic operations were performed and 9 open operations were performed. The time of operation for laparoscopy and open procedure was 55 min and 153 min on average respectively while the hospital stays after operation was 2. 2 days and 8. 6 days respectively. No severe perioperative complications occurred. Subclassification of adrenal cysts by histology included endothelial cysts 86 /156 pseudocysts 67 /156 and epithelial cysts 3 /156. At follow-up no patient suffered recurrence. Conclusions Diagnosis of adrenal cysts predominantly depends on imaging especially enhanced CT. Preoperative endocrinology test is necessary. Surgery is recommended for large cysts greater than 5 cm cystic endocrine active adrenal tumors and cysts with chances of malignancy by imaging. Laparoscopic surgery is preferred as the first option for the surgical treatment of adrenal cysts. Key words adrenal cysts diagnosis treatment surgery laparoscopy % ~ 0. 18% ~ ~ % ~ ~ 11 cm 2. 6 cm % CT 7 CT CT 0 ~ 19 Hu CT cm % B % MRI 22 T1 T ~ % 2 CT B MRI 2 24 h CA 24 h UFC ACTH min d 2 ~ 4 d 8. 6 d 7 ~ 11 d

3 ml 80 Table /9 1 1 within normal tissue 70 Table 1 Operative and postoperative data hemorrhagic 21 items laparoscopic n = 146 open n = 9 unspecified 49 cyst unroofing 6 3 within adrenal tumors 16 adrenalectomy 17 5 adenoma 10 surgical resection pheochromocytoma 6 median duration of surgery min endothelial simple cysts 67 median blood loss ml lymphangiomatous cysts 42 hospital stay of surgery angiomatous cysts 25 complications 0 2 epithelial true cysts 3 wound infection 0 1 cystic adenomas 3 deep vein thrombosis ~ Subclassification of adrenal cysts by histology histologic classification n = 156 pseudocysts 86 Foster 4 3 A. contrast-enhanced CT scan shows the cystic mass with a thin wall with exception of abdominal part B. part of the wall is adrenal tissue C. photomicrograph shows fibrous tissue constitutes the wall of adrenal cyst 1 Fig 1 Pseudocysts

4 A. contrast-enhanced CT scan shows a cystic mass and eggshell calcification B. remote hemorrhage inside the exercised adrenal cyst C. pathological result shows pheochromocytoma 60 Fig 2 2 Pseudocysts within adrenal tumors Pheochromocytoma Fig 3 3 Endothelial cysts Lymphangiomatous cyst 150 CT MRI B % CT CT 2 Foster Neri Nance 2 6 cm CT 8 6% 4 cm CT MRI B 2% cm 1 CT CT CT % CT 5 cm

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