肾上腺平滑肌瘤3例报道并文献复习

doi:10.19558/j.cnki.10-1020/r.2021.03.005

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摘要 目的：总结肾上腺平滑肌瘤患者的诊疗经验,提高对肾上腺平滑肌瘤的认识及诊治水平。方法：回顾性分析武汉同济医院2000–2020年的3例肾上腺平滑肌瘤患者的诊治过程及随访结果,并对已发表的相关文献进行复习总结。结果：3例患者中,2例无症状,1例间断轻度腰胀;1例合并克罗恩病,1例合并慢性乙型肝炎;1例存在促肾上腺皮质激素及血皮质醇升高,另外2例相关激素均在正常范围。影像学检查发现单侧肾上腺肿物,其中1例明显钙化,3例均行后腹腔镜下肾上腺肿物切除术,平均手术时间70 min,术中平均出血量103 mL,术后病理检查确认为肾上腺平滑肌瘤。术后3个月复查,异常的肾上腺相关激素水平均恢复正常,合并症控制良好。随访3~10年,均未复发。相关个案报道多为女性右侧肾上腺区偶发瘤,与HIV及EB病毒感染所致的免疫缺陷状态密切相关。结论：肾上腺平滑肌瘤为良性肿瘤,治疗以手术切除为主,预后良好,其发生可能与自身免疫功能紊乱存在密切关系。

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	张军
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	李恒
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关键词 ：肾上腺平滑肌瘤, 肾上腺偶发瘤, 免疫功能, 后腹腔镜手术, 钙化

Abstract：Objective： To improve the understanding, diagnosis and treatment of adrenal leiomyoma. Methods： From 2000 to 2020, the process of treatment and follow-up outcomes of three adrenal leiomyoma patients in Tongji Hospital were retrospectively analyzed, and the published literatures on this disease were reviewed. Results： Among the three cases, two were asymptomatic and one had intermittent mild lumbar distention. One had Crohn's disease, one had chronic hepatitis B infection. One of them had elevated ACTH and cortisol, and the rest two cases had normal levels of adrenaline-related hormones. Unilateral adrenal incidentaloma was preliminarily diagnosed by imagine test in three cases and one of them had obvious calcification. All patients underwent retroperitoneal laparoscopic adrenalectomy. The mean operation time was 70 min with average bleeding amount of 103 mL. The pathological examination confirmed the diagnosis of adrenal leiomyoma. After three months of operation, all the abnormal hormones and the complications returned to normal. No recurrence occurred within the 3 to 10 years of follow-up. Through review of literatures, we found most of involved cases were female patients with masses located in right adrenal area, and closely associated with the immunity dysregulation. Conclusions： Adrenal leiomyoma is a benign tumor with good prognosis. The ideal treatment is surgical resection of adrenal mass. The occurrence of adrenal leiomyoma might be closely associated with autoimmune dysfunction.

Key words： adrenal leiomyoma adrenal incidentaloma immunity retroperitoneal laparoscopic surgery calcification

收稿日期: 2020-06-18

通讯作者: 栾阳,yangluan@tjh.tjmu.edu.cn

引用本文:

张军, 徐浩, 李恒, 栾阳, 管维. 肾上腺平滑肌瘤3例报道并文献复习[J]. 微创泌尿外科杂志, 2021, 10(3): 167-173.
ZHANG Jun, XU Hao, LI Heng, LUAN Yang, GUAN Wei. Adrenal Leiomyoma: report of 3 cases and review of literatures. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2021, 10(3): 167-173.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1676.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2021/V10/I3/167

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