Clinical Analysis Of Diagnosis And Treatment Of Adrenal Cyst

Objective:To improve the diagnosis and treatment level of adrenal cyst and explore the safety and efficacy of retroperitoneal laparoscopy for the treatment of adrenal cyst.Methods:The retrospective analysis of 21 cases of adrenal cysts in the General Hospital of Tianjin Medical University is carried out according to the clinical data. 219 literatures concerned,which cover from January 1978 to April 2009,are retrieved from CNKI(China National Knowledge Infrastructure) by the keyword "adrenal cyst".According to the clinical manifestation,therapy method and pathological type in those eligible literatures,a meta-analysis is performed.Results:21 cases of adrenal cysts all undergo successful operations and the average time of hospitalization is(7±1.8) d.Among the 17 cases of retroperitoneal laparoscopic surgery,the adrenal hysterectomy is performed on 9 cases,the adrenal partial laryngectomy,3 cases and the cyst fenestration,5 cases.Pathological diagnosis: 7 cases of pseudocyst(3 cases:remote hemorrhage,2 cases:cystic pheochromocytoma and the other 2 cases:no specific description),6 cases of endothelial cyst(all are cystic lymphangioma),3 cases of epithelial cyst and the other 5 cases whose sub-types are not recorded in the pathological report.The parasitic cyst does not exist in the group.After the surgery,the symptoms of patients such as abdominal discomfort,low back pain,nausea,vomiting etc.disappear.Among the 3 cases with high blood pressure,1 case of them has improved and the other 2 cases have no apparent improvement.15 cases are followed up with B-ultrasound examination for 4-27 months.No cyst recurrence is found.Based on the 187 eligible literatures together with the 21 cases in the General Hospital of Tianjin Medical University,the clinical manifestations of 961 cases,the therapy methods of 928 cases and the pathological types of 814 cases are summed up. Adrenal cyst has the following symptoms:lumbodorsal pains(39.3%),abdominal pains and discomfort(17.3%),high blood pressure(10.5%),palpable masses in abdomen(9.3%) and gastrointestinal symptom(2.5%) etc.;however,the majority of patients(36.0%) have no clinical manifestations.As for the therapies,open surgery (76.3%) dominates all others;however,the retroperitoneal laparoscopic surgery and laparoscopic surgery with minimally invasive surgical technology for adrenal cyst have developed rapidly in recent years(15.2%).The other methods of treating adrenal cyst include percutaneous puncture(6.4%) and follow-up(2.1%).According to priority,pathological types are as follows:pseudocyst(44.1%),endothelial cyst (27.3%),epithelial cyst(14.6%),parasitic cyst(0.5%),which is in substantial agreement with foreign statistics.The left(13.5%) are unclassified cysts for the lack of pathological materials.Conclusion:①Adrenal cyst,which is named after its location and form,is of a group of diseases with a very low incidence.According to the classification of pathology,it can be divided into 4 categories,i.e.,parasitic cysts,epithelial cysts,endothelial cysts and pseudocyst.②Most adrenal cysts are found during surgery or autopsy because of their deep location and the lack of obvious clinical symptoms.With the progress in imaging technology,especially the wide use of B-ultrasound in diagnosis and medical examination,more adrenal cysts are found in contrast to the past.Most adrenal cysts can gain the localization diagnosis through the comprehensive application of B-ultrasound,CT and MRI.Because of the lack of specific clinical symptoms together with normal biochemical analysis and normal imaging manifestation,it is hard to make a qualitative diagnosis before the surgery and the qualitative diagnosis is always based on the pathological examination of specimen after the surgery.③The surgical therapy is the primary means of treating adrenal cyst,but there is no uniform surgical indications.Based on the literatures and the treatment experience the General Hospital of Tianjin Medical University has gained,the author argues that cyst has the clinical symptom and the endocrine function,and that cyst should be removed by surgical excision,while the nature of cyst can not be determined.The simple cysts larger than 4cm must be treated with surgery and those smaller than 4cm should be followed up with B-ultrasound and CT.The author also argues that huge adrenal cysts are not an absolute taboo to retroperitoneal laparoscopy.However,the cyst more than 10cm has the great possibility to be malignant tumor and there may be seriously sticky with surrounding tissue. Therefore,the difficulty of surgery should be taken into full account and the preparation of open surgery should be made carefully.④The methods of treating adrenal cyst include adrenal cyst fenestration,partial or total resection of adrenal through the way of open surgery,laparoscopic surgery or retroperitoneal laparoscopic surgery.The retroperitoneal laparoscopic surgery for adrenal cyst has similar efficacy with the open surgery.With the characteristics of less trauma,less blood loss,lighter pain after operation,quicker restoration,less effect on beauty and the shorter length of stay,it has become the first choice of treating adrenal cyst.Generally speaking,the research on the adrenal cyst is superficial and jug-handled until now,especially on its pathogenesis and pathological characteristics. Perhaps,a small number of cases are the negative impact on the study,in addition to its relative dispersion at the pathological type.Most adrenal cysts are benign and have a favorable prognosis.In addition,some special adrenal cysts,such as parasitic cysts, cystic degeneration of pheochromocytoma and cystic degeneration of metastasis tumor,can be treated according to their biological characteristics of the original disease.