摘要
目的:探讨肾上腺出血的临床表现、诊断与治疗。方法:回顾性分析2002～2009年的经影像学和手术病理检查证实的12例肾上腺出血患者的临床资料。结果:12例肾上腺出血患者临床表现很不典型,3例出现肾上腺危象,余肾上腺功能均正常。B超检查10例,均见不均质肿块。12例行CT检查,10例急性出血见高密度肿块,2例慢性出血密度较低,增强CT扫描均无强化。MRI检查5例,显示肾上腺区不均匀肿物,T1加权为高或等信号,T2加权为低信号。3例开放手术治疗,2例予以介入治疗后手术。除1例脓毒血症患者死亡外,余11例均获随访,共随访5～72个月,恢复良好,除2例转移性肿瘤引起的肾上腺出血行双侧肾上腺切除后靠口服糖皮质激素外,其余均无肾上腺皮质功能不全表现。结论:肾上腺出血术前诊断困难,CT、MRI对诊断价值较大。对单侧肾上腺出血>5 cm时应采取介入或手术治疗;对双侧肾上腺出血,则立即予以激素替代治疗的同时准备介入或手术止血;对于肿瘤出血,做好充分的术前准备后择期手术生存率明显高于急诊手术。
Objective ：To Investigate the clinical manifestation of adrenal hemorrhage and to improve the diagnosis and treatment for this disease.Methods ：The clinical data of 12 cases of adrenal hemorrhage confirmed by iconography,surgery and pathology from 2002 to 2009 were reviewed and studied.Results：The clinical manifestations of adrenal hemorrhage in all the 12 cases were extremely atypical. The functions of adrenal glands in 9 cases were all normal except 3 cases＇ adrenal crisis.Ten cases were examined by type-B ultrasonic and displayed uneven masses. All 12 cases underwent CT scan,of which 10 cases displayed hyperdense masses and 2 cases displayed hypodense masses.Five cases underwent MRI, which displayed uneven masses in adrenal glands.The hemorrhage was high signal or iso - signal in T1 weighted image and low signal in T2 weighted image.Three cases were operated and other two cases were operated after transluminal artery embolization （TAE）. No adrenal insufficiency was found during the follow up from 5 months to 72 months apart from 2 cases＇ adrenal glands were both removed because of metastasis and I case was dead because of the severe sepsis.Conclusion：Preoperative diagnosis of adrenal hemorrhage is difficult.CT and MRI are helpfal for the diagnosis.The uniliteral hematoma which exceeds 5 cm in diameter is recommended to takion TAE or operate.Biliteral adrenal hemorrhage needs TAE or operation,meanwhile glucocorticoids were taken orally. As far as tumors＇ hemorrhage is concerned, elective surgery after being well prepared has higher survival rate than emergency surgery.
出处
《现代医药卫生》
2010年第1期16-18,共3页
Journal of Modern Medicine & Health
关键词
肾上腺出血
诊断
治疗
Adrenal hemorrhage
Diagnosis
Treatment
