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目的 提高自发性肾上腺出血的诊治水平。 方法 回顾性总结 1 1例自发性肾上腺出血患者的诊治资料。 结果 1 0例仅表现为患侧腰痛 ,1例为输尿管癌术中发现肾上腺肿物。肾上腺功能均正常。B超检查 1 1例 ,3例表现为囊性肿物 ,其内可见点状、分隔样强回声 ,7例表现为低回声肿物 ,1例输尿管癌术前肾上腺B超正常。 1 0例CT扫描表现为卵圆形、边界清楚低密度病灶 ,CT值 34 .7～ 85 .0HU ,>50 .0HU者 6例 ,其中 1例可见液平面 ;增强CT扫描 3例 ,肿物无强化。MRI检查 3例 ,显示肾上腺区不均匀肿物 ,T1加权像为等信号 ,T2加权像为低信号。行肾上腺及肿物切除术 6例 ;行部分肾上腺及肿物切除术 5例。术后病理为肾上腺髓质内出血 ,血肿外包绕肾上腺组织。术后肾上腺皮质功能正常 ,随访 7个月～ 8年 ,无肾上腺皮质功能低下表现。 结论 B超、CT、MRI可以帮助诊断自发性肾上腺出血。双侧肾上腺出血、腰腹痛症状明显、单侧肾上腺出血但血肿 >5cm者应采取手术治疗 ,行部分肾上腺及血肿切除术 ,尽量保存血肿周围健康肾上腺组织。
Objective To improve the diagnosis and treatment of spontaneous adrenal hemorrhage. Methods The clinical data of 11 patients with spontaneous adrenal hemorrhage were retrospectively reviewed. Results 10 cases showed only ipsilateral low back pain, 1 case of adrenal tumor found during ureteral cancer surgery. Adrenal function are normal. B ultrasound 11 cases, 3 cases showed cystic mass, which can be seen punctate, separated by strong echo, 7 cases showed hypoechoic tumor, 1 case of preoperative ureteral B-adrenal ultrasound. 10 cases of CT scan showed oval, clear low-density border lesions, CT value 34 .7 ~ 85 .0HU,> 50. 0HU in 6 cases, of which 1 case can be seen in the liquid level; enhanced CT scan in 3 cases, mass No strengthening. MRI examination in 3 cases, showing uneven mass in the adrenal area, T1 weighted image is equal signal, T2 weighted image is low signal. 6 cases of adrenalectomy and tumor resection; 5 cases of partial adrenalectomy and tumor resection. Postoperative pathology of adrenal medullary hemorrhage, hematoma outside the adrenal tissue. Postoperative adrenal function is normal, followed up for 7 months to 8 years, no adrenal dysfunction performance. Conclusion B ultrasound, CT, MRI can help diagnose spontaneous adrenal hemorrhage. Bilateral adrenal hemorrhage, abdominal pain obvious symptoms, unilateral adrenal hemorrhage but hematoma> 5cm surgical treatment should be taken, the line of partial adrenalectomy and hematoma resection, try to save the healthy adrenal tissue around the hematoma.