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作者对2例肾上腺肿瘤实行了经导管动脉栓塞(TAE)术,1例成功,1例失败,报道如下。 例1,女,45岁,血浆皮质醇基础水平25.2μg/dl(正常5～20μg/dl),无正常的昼夜分泌变化。尿17-羟皮质类固醇清除率是21.2μg/天(正常2.2～7.3μg)。CT及同位素检查显示,左肾上腺见一直径5cm,边界清楚、规则,均匀强化的肿瘤,无转移。因患者有活性结核,无法手术,而使用TAE方法。血管造影术,肿瘤染色主要来自肾上腺下动脉。经微导管注入E-1溶液(3.4g欧乃派克粉+2ml盐水+无水酒精共10ml)栓塞。术后即刻行CT检查示E-I溶液分布于肿瘤的绝大部分,当天给予总量200mg糖皮质激素,2天后血浆皮质醇水平降至正常范围(18.4μg/dl)。第4天改为口服氢化可的松,第8天停药。6个月后CT示肿瘤栓塞部分坏死。术中术后无并发症,随访9个月病人临床症状改善,血浆皮质醇水平下降。
The authors performed transcatheter arterial embolization (TAE) on 2 adrenal tumors. One case was successful and one case was unsuccessful. It was reported as follows. Example 1, female, 45 years old, plasma cortisol basal level 25.2μg/dl (normal 5 ~ 20μg/dl), no normal diurnal secretion changes. The urinary 17-hydroxycorticosteroid elimination rate was 21.2 μg/day (normal 2.2-7.3 μg). CT and isotope examinations showed that the left adrenal gland had a diameter of 5 cm, clear and regular borders, uniformly enhanced tumors, and no metastases. Because patients have active tuberculosis and cannot be operated, the TAE method is used. Angiography, tumor staining mainly from the adrenal artery. A microcatheter was used to inject the E-1 solution (3.4 g of Ouopike powder + 2 ml of saline + 10 ml of absolute alcohol) into the embolization. CT examination immediately after the operation showed that the E-I solution was distributed in most of the tumors. A total of 200 mg of glucocorticoid was given on the day. After 2 days, plasma cortisol levels fell to the normal range (18.4 μg/dl). On the 4th day, oral hydrocortisone was discontinued and was discontinued on the 8th day. After 6 months, CT showed partial necrosis of tumor embolism. There were no complications during and after surgery. After 9 months of follow-up, the clinical symptoms improved and plasma cortisol levels decreased.