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目的:探讨胃憩室表现为左肾上腺假瘤的临床特点、诊断和治疗方法。方法:回顾性分析1例胃憩室表现为左肾上腺假瘤患者的临床资料。男性,15岁,因血压升高1个月,发现左肾上腺占位20天入院,超声检查提示左肾上腺区1.6cm×1.4cm等回声占位,边界欠清。CT平扫:左肾上腺可见一2.4cm×1.5cm高密度占位,CT值70HU。复查增强CT:左肾上腺区低密度灶,最大截面2.0cm×1.5cm,平扫-1 HU,增强后约10HU,其内可见气体影。结果:患者行腹腔镜肾上腺肿瘤切除,术中游离肾上腺过程中未见明确肿物,给予肾上腺分段切除并取出剖开,直至全部切除肾上腺后仍未见肿瘤。但左肾上腺毗邻腹膜内似有肿物突向肾上腺区,术中请外科会诊阅片并结合术中情况考虑有胃憩室可能,建议术中胃镜,胃镜可见贲门旁2cm处可见直径2.5cm的憩室,憩室内可见少量食物残渣。切除之肾上腺病理回报:左肾上腺皮质呈局灶性结节性增生。患者恢复良好,术后4天出院。结论:胃憩室临床罕见表现为左肾上腺假瘤。尽管罕见,胃憩室也应为左肾上腺肿瘤的鉴别诊断之一,尤其对于肿物内有气体影像时,应高度怀疑假瘤的可能。
Objective: To investigate the clinical features, diagnosis and treatment of left adrenal pseudotumor in gastric diverticulum. Methods: A retrospective analysis of 1 case of gastric diverticulum showed left adrenal pseudotumor in patients with clinical data. Male, 15 years old, due to elevated blood pressure for 1 month, found left adrenal gland occupied 20 days admitted to the hospital, ultrasound examination prompted the left adrenal area 1.6cm × 1.4cm and other echo occupy the border less clear. CT scan: The left adrenal can be seen a 2.4cm × 1.5cm high-density space occupancy, CT value 70HU. Review of enhanced CT: low-density left focus on the left adrenal area, the largest cross-section 2.0cm × 1.5cm, plain -1 HU, enhanced about 10HU, which can be seen gas shadow. Results: The patients underwent laparoscopic adrenalectomy. There was no definite tumor in the free adrenalectomy. The adrenal gland was segmented and removed. The tumors were not seen until the whole adrenalectomy. But the left adrenal adjacent to the peritoneal tumor mass appears to the adrenal area, intraoperative surgical consultation film and combined with intraoperative consideration of gastric diverticulitis may suggest intraoperative gastroscopy, gastroscopy can be seen near the cardia 2cm at a diameter of 2.5cm diverticulum , Diverticulum shows a small amount of food residue. Ablation of the adrenal pathological findings: left adrenal cortex was focal nodular hyperplasia. The patient recovered well and was discharged 4 days after the operation. Conclusion: Gastric diverticulitis is a rare clinical manifestation of left adrenal pseudotumor. Although rare, gastric diverticulum should also be one of the differential diagnosis of left adrenal tumors, especially for the presence of gas imaging in the tumor, the possibility of pseudotumor should be highly suspected.