A Retrospective Study Of The Diagnosis And Treatment Of Adrenal Ganglioneuromas

Background and objectsBy analyzing the clinical data of patients with adrenal ganglion cell neuroma who are treated in the First Affiliated Hospital of Zhengzhou University,we can improve the understanding of this disease.and the safety and effectiveness of surgical treatment fo this disease were discussed,so as to provide experience for the clinical diagnosis and treatment in the future.MethodsThe complete clinical data of 43 patients with adrenal ganglion cell neuroma who received surgical treatment in the First Affiliated Hospital of Zhengzhou University from January 2010 to June 2019 were collected,and the relevant data including general data,clinical manifestations,examination,diagnostic basis,surgical method,perioperative indicators and postoperative follow-up were retrospectively analyzed.SPSS22.0 software was used to analyze the collected data.Continuous variables were expressed as Mean±SD table,and counting data were expressed as percentage(%).Comparison of measurement data between groups was performed by T test,and P<0.05 was considered statistically significant.Results1.About 43 patients were enrolled,including 19 males(44.2%)and 24 females(55.8%),the ratio of males to females was 1:1.26.The range of age was from 11 years to 64 years.The average age was 36.6±12.67 years.There were 18 cases on the left side,25 cases on the right side(58.1%),and the ratio of left and right positions was(1:1.4).There were 26 cases of asymptomatic patients,12 cases of lumbar(abdominal)pain or discomfort,4 cases of hypertension,and the remaining 1 case of hypertension,palpitation and general weakness.Potassium in the blood was 2.9 mmol/L,who was diagnosed preoperatively as PHA.2.28 patients received preoperative ultrasonography,24 showed homogeneous hypoeehoic mass,and 4 showed heterogeneous adrenal area echo.Blood flow signals of AGN were detectable in 4 cases.3.All patients underwent CT plain scan and enhancement.On CT plain scan,40 patients presented as round and homogeneous low-density masses,and the other 3 patients presented as heterogeneous masses with cystic change.After enhanced scan,33 cases showed no obvious or mild enhancement in arterial phase,progressive mild to moderate enhancement in venous phase,no obvious enhancement in 5 cases,and uneven obvious enhancement in 2 cases.The other 3 patients presented mild to moderate progressive enhancement in the uncystic changes.4.About 7 patients underwent MRI,all of which showed homogeneous low signal of T1 WI and heterogeneous high signal of T2WI.5.All the 43 patients underwent surgical treatment,and the operation went smoothly without transfer to open.Among them,37 patients(86.0%)underwent laparoscopic surgery and 6 patients(14.0%)underwent open surgery,without serious complications.The mean operative time of laparoscopic surgery and open surgery was(67.1±15.8)min and(147.6±21.3)min(P<0.05),the mean intraoperative blood loss was(96.2±15.6)ml and(330±269.8)ml(P<0.05),the mean intestinal recovery time was(1.7±1.2)and(2.9±1.7)days(P<0.05),the total postoperative drainage volume was(70.5±41.3)ml and(147.6±21.3)ml(P<0.05),postoperative drainage tube removal time was(2.9±1.5)and(4.6±2.1)days(P<0.05),and the postoperative hospital stay was(5.5±2.5)and(9.2± 2.4)days(P<0.05).All perioperative indexes of the laparoscopic group were superior to those of the open surgery group.6.The patients were followed up for 6-108 months postoperatively,and all the 43 patients were followed up without recurrence or metastasis.One patient with hypertension,palpitation,systemic weakness and hypokalemia returned to normal after operation.Blood pressure returned to normal after operation in 2 patients with hypertension.Preoperative endocrine examination was abnormal,and postoperative review returned to normal.Conclusions1.Adrenal ganglion cell neuroma is a rare clinical disease.Its clinical manifestations are mostly non-specific.Imaging examination is helpful for preoperative diagnosis of this disease,but postoperative pathological results arestill necessary for diagnosis.2.Surgery is an effective method to treat adrenal ganglion cell neuroma.Compared with open surgery,endoscopic surgery has the characteristics of fast recovery and less damage.The prognosis of this disease is good and postoperative chemoradiotherapy is not required.