目的 探讨肾上腺髓性脂肪瘤的诊断与治疗方法.方法 回顾性分析18例肾上腺髓性脂肪瘤患者的临床资料,总结诊断和治疗经验.18例病例中,11例无症状,5例有腰部疼痛不适,2例血压增高.B超、CT或MRI诊断17例,1例误诊为肾上腺错构瘤.肿瘤发生于左肾上腺区10例,右肾上腺区8例.开放性手术12例,腹腔镜手术6例.结果 18例患者的手术均顺利完成.手术时间 60～220min,平均130min.术中出血10～700mL,平均80mL.1例患者因失血较多(700mL)输血400 mL,其余患者术中及术后均无输血.患者住院4～10天,平均6天,术中及术后均无手术并发症.肿瘤直径5～10cm,术后病理检查证实均为肾上腺髓性脂肪瘤.术后随访6个月～5年,无肿瘤复发.结论 肾上腺髓性脂肪瘤多无特异性临床表现,术前诊断主要依赖于影像学检查,病理检查方可确诊,手术切除预后良好.腹腔镜手术创伤小、疗效满意,是较为理想的治疗方法.%Objective To study the diagnosis and management of adrenal myelolipoma. Methods The clinical data of 18 cases of patients with adrenal myelolipoma were analyzed retrospectively and the literature were reviewed. No specific clinical symptom and endocrine abnormally were noted in this group of patients,except 5 cases with lumbodynia and 2 cases with hypertension. All cases but one were diagnosed by ultrasound scanning,CT scan or MRI. Tumors located in the left adrenal gland in 10 cases and right in 8. Open surgery were conducted in 12 cases and laparoscopic surgery in 6 cases. All cases were surgically treated. Results All the surgeries were finished successfully. The mean operation time was 130 min (60 - 220 min). The mean amount of bleeding was 80 mL (10 - 700 mL). One case needed transfusion of 400 mL red cell suspension because of blood loss (700 mL). The mean hospital stay was 6 days (4 - 10 days) with no complication. The diameters of the tumor were 5 to 10 centimeters. All cases were diagnosed as having adrenal myelolipoma by pathology. The duration of follow up was 6 months to 5 years after surgery. No recurrence was observed in all cases. Conclusions Adrenal myelolipoma shows rarely specific clinical symptoms, and the diagnosis was mainly established by adrenal imaging examinations. The surgical resection has an excellent effect and laparoscopic operation could be as a good method because of its little trauma and quick recovery.
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