Τυχαίος όγκος της επινεφρίδας

　　1、发病原因

　　无功能的肾上腺皮质腺瘤的频率最大，占36%～94%，能分泌激素的肾上腺腺瘤包括皮质醇分泌瘤，醛固酮分泌瘤和嗜铬细胞瘤占的比例很低。原发性肾上腺皮质腺癌占0～25%。肾上腺转移瘤的比例很高，其中患者有已知恶性肿瘤者肾上腺转移癌的出现频率为32%～73%，而不知有恶性肿瘤的患者肾上腺转移癌只占0～21%，其他原因的肾上腺意外瘤较少。

　　2、发病机制

　　目前对肾上腺意外瘤的发病机制不甚清楚。有文献报道可能与促肾上腺皮质激素(ACIH)的长期刺激有关，或长期高血压导致肾上腺动脉硬化而产生的继发性改变。不少学者试图从分子遗传学方面来探讨意外瘤的起因，目前对某些遗传综合征合并肾上腺意外瘤的分子研究已经取得了一定的进展。

　　大多数肾上腺意外瘤为无高分泌功能的良性腺瘤，临床和实验室检查均无激素分泌增多的表现。本病主要并发皮质醇、雄激素、雌激素、盐皮质激素或儿茶酚胺分泌增高，以相应激素增多引起的临床表现为主，如皮质醇增多常有向心性肥胖、高血压、糖耐量异常及骨质疏松等表现。

　　大多数肾上腺意外瘤为无高分泌功能的良性腺瘤，临床和实验室检查均无激素分泌增多的表现，高功能的肾上腺意外瘤主要分泌皮质醇，雄激素，雌激素，盐皮质激素或儿茶酚胺，以相应激素增多引起的临床表现为主，如皮质醇增多常有向心性肥胖，高血压，糖耐量异常及骨质疏松等表现，部分高分泌功能的肾上腺意外瘤无明显的临床症状称为寂静型高功能腺瘤，包括皮质醇分泌瘤，醛固酮分泌瘤及嗜铬细胞瘤，对此类皮质醇分泌瘤有人称为亚临床库欣综合征。

　　1、注意既往史及患者伴发症状：临床上一旦发现肾上腺意外瘤，首先应全面了解患者的病历资料，如有可疑的临床症状，既往病史尤其肿瘤及原发性高血压等。

　　2、应尽快明确肿瘤的确切部位：对偶然发现的肿块的定位很重要，即应明确肿块是否位于肾上腺，我院曾对1影像学提示肾上腺肿块的患者进行探查发现肿块为黄体血肿。

　　3Για τους ασθενείς που确定了肾上腺意外瘤，应进一步全面评估肿块是否有激素分泌功能，包括肾上腺皮质和髓质激素，对于临床怀疑为嗜铬细胞瘤的患者，必要时可行药理激发或抑制试验，此外应用131Ⅰ-MIBG radionuclide imaging has certain value in the qualitative and locational diagnosis of pheochromocytoma.

　　4, The discovery of adrenal incidentaloma in tumor patients is a relatively complex clinical problem, and such patients' autopsies found36% have adrenal metastasis, in patients with no malignant tumors found incidentally adrenal incidentaloma, rare malignancy.

　　5, Imaging examinations have a certain guiding role in the judgment of the nature of adrenal incidentaloma, especially CT, including the location, size, CT value, and whether the enhancement examination can be enhanced, etc.

　　6, It should be noted that some functional adrenal cortical tumors may not have caused changes in hormone levels at the time of detection, and dynamic observation should be made, or iodinated cholesterol scanning should be performed to clarify whether they have function.

　　7, It is not reliable to judge the benign or malignant nature of tumors solely based on their size, and a comprehensive determination should be made based on clinical data.

　　It should be noted that it is not advisable to undergo immediate surgical treatment as soon as an adrenal incidentaloma is found. A 'big operation' for a mass with no obvious clinical significance, in addition to causing physical trauma, undoubtedly also increases the psychological and economic burden on the patient; while for masses with potential danger, such as adrenal cancer, if not treated in time, it can lead to the death of the patient.

　　Due to the uncertainty of the nature of adrenal incidentaloma, there is currently no absolute clinical, biochemical, and pathological diagnostic criteria.

　　For patients diagnosed with adrenal incidentaloma, a further comprehensive evaluation should be made to determine whether the mass has hormone secretion function, including adrenal cortex and medulla hormones. For those suspected of having pheochromocytoma, pharmacological stimulation or inhibition tests can be performed when necessary, in addition to131Ⅰ-MIBG radionuclide imaging has certain value in the qualitative and locational diagnosis of pheochromocytoma.

　　Imaging examinations have a certain guiding role in the judgment of the nature of adrenal incidentaloma, especially CT, including the location, size, CT value, and whether the enhancement examination can be enhanced, etc.

　　1, Lotus leaf porridge:a piece of fresh lotus leaf, glutinous rice100 grams, a little rock sugar. ① Wash the glutinous rice clean, and wash the fresh lotus leaf clean, cut into pieces one inch square. ② Put the fresh lotus leaf in a pot, add a moderate amount of clear water, boil with high heat, then simmer with low heat10minutes to15minutes, remove the residue and keep the juice. ③ Put the glutinous rice and lotus leaf juice in a pot, add a moderate amount of rock sugar and clear water, boil with high heat, then simmer with low heat until the rice is soft and turns into porridge. Take it every day2times, as breakfast and dinner.

　　2, Red bean porridge:red beans30 grams, glutinous rice50 grams. Wash the red beans and glutinous rice, put them in a pot, add clear water, and cook until the rice is soft and turns into porridge. Take it every day2times, as breakfast and dinner. Long-term consumption can promote diuresis and dampness, invigorate the spleen, and reduce weight.

　　3, Oatmeal porridge:oat flakes50 grams. Place the oat flakes in a pot, add clear water, stir and cook until soft. Or use milk250 milliliters, boil with oat flakes to make porridge. Take once a day, during breakfast. It has the effects of lowering blood fat and weight loss, suitable for obesity, hyperlipidemia, coronary heart disease patients, and daily health care for the healthy.

　　4, Poria cakes:Poria200 grams, flour100 grams. Grind the Poria into powder, mix it with flour and water to make cakes, and then fry until done. Regular consumption has the effects of invigorating the spleen and eliminating dampness, nourishing the stomach, and is suitable for long-term use.

　　5、鲜拌三皮：西瓜皮200克，黄瓜皮200克，冬瓜皮200克。将西瓜皮刮去蜡质外皮，冬瓜皮刮去绒毛外皮，与黄瓜皮一起，在开水锅内焯一下，待冷却后切成条状，放入少许盐，味精，装盘食用。可经常食用，具有清热利湿，减肥之效。

　　一、治疗

　　1、肾上腺意外瘤的治疗原则

　　（1）有激素分泌功能的应手术切除。

　　（2）肿瘤直径≥4cm的应手术切除。

　　（3）如明确为转移瘤，只影响一侧肾上腺，对侧肾上腺及其他部位都未发现转移瘤者，也可以将肾上腺转移瘤手术切除。

　　（4）直径

　　（5）肾上腺囊肿、髓脂瘤、血肿/出血、肾上腺结核，先天性肾上腺皮质增生等无手术的必要。经典的手术方法是经腰切口入路的开放式手术。现在中国外都有用腹腔镜进行手术的报道。腹腔镜手术有经腹腔，也有不经腹腔在腹膜后进入的。这种内镜手术创伤小，出血少、恢复快，但要求的技术比较高。肿瘤比较大或怀疑是恶性肿瘤者，最好选择开放式手术。

　　2、目前对肾上腺意外瘤的处理，国外更倾向于采取积极主动的措施，对有激素分泌功能的肿块行手术切除，无激素分泌功能的肿块进行细针穿刺活检，如为恶性肿瘤或转移癌则采取手术切除或治疗原发癌；对于肿块体积大于5cm以及影像学疑为癌的患者也采取手术切除，小于5cm的肿块则随访观察，定期复查。

　　3、应注意对保守治疗的患者进行影像学及激素水平的动态监测一般每6Μήνας επανελέγχου CT, αν η όγκος αυξάνεται, πρέπει να αφαιρεθεί χειρουργικά. Για τους ασθενείς με καρκίνο της επινεφρίδας που δεν μπορεί να αφαιρεθεί χειρουργικά, μπορεί να χρησιμοποιηθεί O, P'-DDD και άλλες θεραπείες化疗药物治疗.

　　Δεύτερος τύπος, πρόγνωση

　　Η διαχείριση της ανεξήγητης όγκου της επινεφρίδας είναι ένα πολύ δύσκολο πρόβλημα που αντιμετωπίζουν οι ιατρικοί επαγγελματίες, και η σωστή διαχείριση μπορεί να βελτιώσει την ποιότητα ζωής των ασθενών και να βελτιώσει την πρόγνωση.