The Clinical Diagnosis And Treatment Analysis Of 85 Cases Adrenal Tumors(Diameter Of 5 Cm Or Higher)

Objective: The clinical data of 85 patients with adrenal tumors(diameter of 5 cm or higher) was retrospectively analyzed, and we explored the method choice, surgical approach, intraoperative risk and pathological characteristics to provide the clinical basis for the clinical diagnosis and treatment reference.Method: The clinical data of 85 patients with adrenal tumors(diameter of 5 cm or higher) who had an operation from Feb. 2007 to Feb 2012 was gathered. CT examination results showed that the tumors had a diameter of 5.0 cm or more, parallel operation treatment, and pathology confirmed patients with adrenal tumors. By using X-ray inspection method, we carried out a statistical analysis on the clinical data of patients with adrenal tumors(diameter of 5 cm or higher), including gender, tumor location, size, laboratory examination, imaging examination, operation time,intraoperative blood loss, intraoperative complications and ICU transfer rate, blood pressure recovery after operation, postoperative follow-up situation, etc.Results:(1)Postoperative pathology showed malignant adrenal tumors in 16 cases.Adrenocortical carcinoma(ACC), 10 cases 3 cases of malignant melanoma, and adrenal malignant fibrous cell carcinoma in 1 case, and adrenal metastatic clear cell carcinoma in 1 case, malignant pheochromocytoma in 1 case(postoperative recurrence one year).Benign adrenal tumor, 69 cases, including 23 cases of adrenal cortical adenoma, and adrenal medullary lipoma 19 cases pheochromocytoma(PHEO) 14 cases, 4 cases were teratoma, mixed PHEO, 3 cases(PHEO with neuroblastoma components in 2 cases, adrenal paraganglioma in 1), 5 cases were teratoma,schwannoma in 3 patients, ganglion cells neuroma in 2 cases.(2)85 cases of adrenal tumor resection in our hospital were successful.The average surgery time was 121.23 ±28.22 min. The average intraoperative blood loss was277.3±68.0 ml, blood transfusion rate was 28.24%(24/85), postoperative into ICU rate was 15.29%( 13/85), postoperative hospitalization time of 12.5 days on average.Surgical complications: in 8 cases of serious complications, including peritoneal loss in23 cases, 1 case of renal vein injury, 2 cases of pleural damage, hypertensive crisis,shock in 1 case.Conclusion:(1)By analyzing the patients with adrenal tumors(diameter of 5 cm or higher), we conclude that ACC is more common in the maligment tumor(9/16). PHEO benign tumors are in the majority among benign ones.Due to the anatomic characteristics of adrenal gland, we have the surgical removal of adrenal tumors(diameter of 5 cm or higher). Because of intraoperatie bleeding and severe peripheral viscera injury, serious complications accur,which increases the risk of surgery.Although the uropoiesis surgical department of minimally invasive technology matures, it is no longer a laparoscopic surgery contraindications due to the anatomical features of adrenal tumors(diameter of 5 cm or higher). Because of the special tumor anatomical location and high degree of correlation with the surrounding, it should be careful to choose the surgical approach and operation method to reduce the operation difficulty and the corresponding risk as much as possible. In order to ensure operation safety, clinicians need to have rich experience and preoperative multidisciplinary collaboration. So that we can reduce the operation difficulty and reduce the corresponding risk at the same time.