Table of Content

20 April 2023, Volume 38 Issue 4

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Meta-analysis of risk factors for pancreatic pseudocyst in acute pancreatitis

Ma Mingfu, Wei Zhiguo, He Tieying

2023, 38(4):  293-301.  doi:10.3969/j.issn.1004-583X.2023.04.001

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Objective To evaluate the risk factors of pancreatic pseudocysts in acute pancreatitis using a meta-analysis system, providing evidence based medical evidence for the prevention and treatment of pancreatic pseudocyst. Methods All relevant literature included in Medline database, Embase, Cochrane Library, web of science, CNKI, CBM, Wanfang database and VIP database from the establishment to November 2022 were first searched. The literature were then screened according to the inclusion and exclusion criteria. The Newcastle-Ottawa Scale (NOS) was used for quality evaluation. Review Manager 5.4 and Stata 14 software were applied for meta-analysis. Publication bias was evaluated by Funnel plot. Results A total of 14 articles were finally included. Meta-analysis results showed that male OR=3.94, 95%CI=(2.12-7.31), P<0.01; diabetes history OR=2.62, 95%CI=(2.04-3.36), P<0.01; CT severity index (CTSI) OR=1.5, 95%CI=(1.31-1.72), P<0.01; serum albumin level OR=0.88, 95%CI=(0.83-0.92), P<0.01; previous drinking history OR=4.36, 95%CI=(2.77-6.88), P<0.01; previous history of pancreatitis OR=2.73, 95%CI=(1.15-6.51), P<0.01; the differences were statistically significant. Conclusion Male, diabetes history, CTSI, serum albumin level, previous drinking history, and previous history of pancreatitis were associated with acute pancreatitis complicated with pancreatic pseudocyst.

Meta-analysis of different positron emission tomography/computed tomography imaging agents in the diagnosis of gliomas

Liu Fei, Lin Zhichun, Yue Jianlan, Yin Liang, Huang Shiming

2023, 38(4):  302-307.  doi:10.3969/j.issn.1004-583X.2023.04.002

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Objective To evaluate the diagnostic value of positron emission tomography/computed tomography (PET/CT) imaging with different radionuclide agents in the diagnosis of gliomas.Methods Diagnostic clinical trials of different imaging agents for gliomas were searched in the Chinese and English language databases. Original data like the true positive, false positive, true negative and false negative were extracted from eligible literatures. Meta - Discl 1.4 was used data analysis. The sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under SROC curve (AUC) of PET/CT imaging using different imaging agents in the diagnosis of glioma were calculated. Results A total of 14 eligible literatures were included, involving 9 describing ¹⁸F-fluorodeoxyglucos (¹⁸F-FDG) imaging, 8 describing ¹¹C-Methionine (¹¹C-MET) imaging, 3 describing ¹⁸F-fluoro-ethyl-L-tyrosine (¹⁸F-FET) imaging, 1 describing ¹³N-NH₃ imaging, and 1 describing O-(2-¹⁸F-fluoroethyl)-L-tyrosine (¹⁸F-FLT) imaging. The data of ¹⁸F-FDG, ¹¹C-MET and ¹⁸F-FET were analyzed and compared. The results showed that the SEN and diagnostic performance (AUC value) of ¹¹C-MET and ¹⁸F-FET PET/CT for gliomas were significantly higher than those of ¹⁸F-FDG (P<0.05). However, there were no significant differences in SPE, PLR, NLR and DOR between groups (P>0.05). Conclusion ¹¹C-MET and ¹⁸F-FET PET/CT imaging are superior to ¹⁸F-FDG PET/CT imaging in the diagnosis of gliomas.

Analysis of clinical characteristics and readmission risk factors in patients with ejection fraction preserved heart failure combined with atrial fibrillation

Wang Zhen, Yang Xiaoyue, Li Shaojie, Wang Xian, Chen Shuxia, Gu Jian

2023, 38(4):  308-314.  doi:10.3969/j.issn.1004-583X.2023.04.003

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Objective To investigate the clinical characteristics and readmission risk factors of patients with ejection fraction preserved heart failure (HFpEF) and atrial fibrillation (AF). Methods The clinical data of 459 patients with HFpEF hospitalized at the Hebei General Hospital from June 2018 to May 2020 were retrospectively analyzed, and they were allocated to AF group (n=242) and sinus rhythm (SR) group (n=217) based on the presence or absence of AF during hospitalization. The clinical data of the two groups were compared, the clinical characteristics of patients with HFpEF and AF were analyzed; further, the readmission risk factors were discussed. Results Compared with those of the SR group, patients in the AF group presented significantly older age, lower proportion of smokers, body mass index (BMI), systolic blood pressure (SBP), proportion of comorbidities of hyperlipidemia and ischemic cardiomyopathy, and proportion of using neprilysin inhibitors, calcium antagonists and antiplatelet drugs, andhigher proportion of comorbidities of somatization disorder and heart valve disease, left ventricular end-systolic diameter, pulmonary artery systolic pressure, B-type natriuretic peptide, left and right atrium diameter, right ventricular diameter, and proportion of using anticoagulant and digitalis(all P<0.05). Univariate and multivariate logistic regression analysis showed that somatization disorder, type 2 diabetes, hyperuricemia, β-blockers were independent risk factors for readmission in patients with HFpEF and AF. Conclusion There were significant differences in clinical profiles between HFpEF patients with and without AF. The comorbidities such as type 2 diabetes, hyperuricemia, and the somatization disorder may be risk factors for readmission in patients with HFpEF and AF, whereas β-blockers may be an independent protective factor for it.

Correlation between serum lipoprotein-associated phospholipase A2 level and the severity and prognosis of acute ischemic stroke

He Xiangyu, Pan Yan, Zhang Xiaolin

2023, 38(4):  315-318.  doi:10.3969/j.issn.1004-583X.2023.04.004

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Objective To explore the correlation between serum lipoprotein-associated phospholipase A2 (Lp-PLA2) level and the severity and prognosis of acute ischemic stroke (AIS). Methods From April 21, 2021 to April 21, 2022, forty-nine healthy volunteers receiving physical examination in our hospital were selected as the control group, and 49 patients with AIS were selected as the observation group. On admission, serum Lp-PLA2 level was detected by enzyme-linked immunosorbent assay (ELISA), and the severity of the disease was assessed by the National Institutes of Health Stroke Scale (NIHSS). Three months after discharge, the Modified Rankin Scale (mRS) was used to evaluate the prognosis, and the correlation between serum Lp-PLA2 level and the severity of disease was analyzed. Risk factors affecting the prognosis of AIS were identified. Results (1) There were no significant differences in drinking history, smoking history, disease history and body mass index (BMI) between the observation group and the control group (P>0.05). Serum Lp-PLA2 level in the observation group was significantly higher than that in the control group (P<0.05). (2) Among 49 patients with AIS, there were 19 mild cases, 16 moderate cases and 14 severe cases. There were significant differences in serum Lp-PLA2 levels and NIHSS score among them (P<0.05). (3) Among 49 patients with AIS, thirty-five patients had good prognosis and 14 had poor prognosis. There was no significant difference in the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification between patients with good prognosis and poor prognosis (P>0.05). Patients with good prognosis had a significantly shorter period from onset to hospitalization, and significantly lower serum Lp-PLA2 level than those with poor prognosis (both P<0.05). (4) Multivariable logistic regression analysis showed that age and serum Lp-PLA2 level were the main factors affecting the prognosis of AIS (P<0.05). Conclusion In patients with AIS, a high serum Lp-PLA2 level indicates a poor condition, which is a risk factor for the prognosis of AIS.

Effect of dialectical behavior therapy combined with sertraline on adolescent depression disorder with non-suicidal self-injury

Duan Dengai, Deng Yan, Zhang Zhixiong, Gu Zhanglin

2023, 38(4):  319-323.  doi:10.3969/j.issn.1004-583X.2023.04.005

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Objective To explore the effects of dialectical behavior therapy (DBT) combined with sertraline on the efficacy and coping styles of adolescent depression disorder with non-suicidal self-injury (NSSI). Methods From June 2020 to December 2021, patients with adolescent depressive disorder with NSSI who were hospitalized in Mental Hospital of Yunnan Province were enrolled in this study. According to the order of enrollment, the patients were divided into two groups, including: the combination group (35 cases) and the control group (35 cases). The control group received sertraline treatment, while the combination group received DBT and sertraline treatment. At baseline (T0), 6 weeks later (T1), and 6 months later (T2), the Hamilton Depression Scale (HAMD), Adolescent Non-suicidal Self-injury Assessment Questionnaire, Simplified Coping Style Questionnaire were used for measurement, and repeated measures analysis of variance was compared between the two groups. Results At T0, there was no significant difference in demographic data and questionnaire scores between the two groups (P>0.05). There were significant differences in total suicide score, HAMD, positive coping and negative coping scores between the two groups at T1 and T2 (P<0.05). The combination group showed a more significant decrease in total suicide score, HAMD and negative coping scores, whereas a more significant increase in positive coping score. The differences in total suicide score, HAMD and negative coping score between the two groups existed in the interaction of time point×group. Conclusion Providing DBT intervention to adolescent depression disorder patients with NSSI can lower HAMD score, reduce the occurrence of NSSI behavior, improve positive coping styles and discard negative coping styles, and have better durability.

Correlation between serum CTRP5 and left ventricular diastolic dysfunction in patients with continuous ambulatory peritoneal dialysis and its diagnostic value

Li Hengnan, Huang Yan, Zhao Yajuan, Hu Guicai

2023, 38(4):  324-329.  doi:10.3969/j.issn.1004-583X.2023.04.006

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Objective To investigate the correlation between serum complement C1q/tumor necrosis factor related protein 5 (CTRP5) and left ventricular diastolic dysfunction (LVDD) in patients with continuous ambulatory peritoneal dialysis (CAPD), and to evaluate the diagnostic value of serum CTRP5 for LVDD in CAPD patients. Methods A total of 114 CAPD patients who were regularly followed up and treated at the Affiliated Hospital of Chengde Medical College from December 2020 to August 2021 were selected, and their clinical data were collected. Patients were allocated to LVDD group (n=85) and normal left ventricular diastolic function (NLVDD) group (n=29) based on the presence or absence of LVDD. The multivariate Logistic regression analysis was performed to explore the independent risk factors of LVDD in CAPD patients, and diagnostic models were established based on each independent risk factors. The diagnostic value of various risk factors and diagnostic models for LVDD in CAPD patients was assessed using receiver operating characteristic (ROC) curves. Results Compared with those in NLVDD group, patients in LVDD group were older, and the proportion of diabetes, systolic blood pressure, serum CTRP5, and brain natriuretic peptide (BNP) levels were significantly higher, while albumin levels were significantly lower (P<0.05). Multivariate logistic analysis showed that age, serum CTRP5, and BNP were independent risk factors for LVDD in CAPD patients (P<0.05). The ROC curve showed that the area under the curve (AUC) of serum CTRP5 for diagnosing LVDD in CAPD patients was 0.902(95%CI: 0.828-0.975), with a cut-off value of 36.78 ng/ml (sensitivity=0.894, specificity=0.862). The AUC of LVDD in CAPD patients diagnosed with serum BNP was 0.886(95%CI: 0.821-0.950), with a cut-off value of 748.22 pg/ml (sensitivity=0.859, specificity=0.759). The AUC of LVDD in CAPD patients diagnosed with age was 0.773(95%CI: 0.678-0.868), with a cut-off value of 47.50 years old (sensitivity=0.753, specificity=0.690). A diagnostic model for predicting the risk of LVDD in CAPD patients was as follows: Y=-12.472+0.139×CTRP5+0.005×BNP+0.083×Age. The AUC of LVDD in CAPD patients diagnosed with this model was 0.933(95%CI: 0.875-0.991), with a cut-off value of 0.401(sensitivity=0.918, specificity=0.897).Conclusion Age, serum CTRP5, and BNP are independent risk factors for LVDD in CAPD patients. The diagnostic efficacy of the diagnostic model based on the independent risk factors of LVDD in patient with CAPD is better than a single indicator, providing clinical reference for timely detection of LVDD in CAPD patients.

Evaluation of hemoperfusion and continuous renal replacement therapy in paraquat poisoning patients complicated with MODS

Tao Yang, Pan Qingquan, Li Yan

2023, 38(4):  330-334.  doi:10.3969/j.issn.1004-583X.2023.04.007

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Objective To investigate the efficacy of hemoperfusion (HP) and continuous renal replacement therapy (CRRT) in paraquat (PQ) poisoning patients complicated with multiple organ dysfunction syndrome (MODS). Methods A total of 56 acute PQ poisoning patients complicated with MODS who received treatment from January 2019 to January 2022 were enrolled and retrospectively analyzed, including 27 patients treated with HP and 29 patients treated with HP+CRRT. The liver and kidney function, blood gas analysis, MODS score and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score before and after treatment were compared between the two groups. Kaplan Meier survival analysis was used to compare the survival rates of different treatment methods. Results There was no significant difference in blood biochemistry, blood gas analysis parameters, MODS and sequential organ failure assessment (SOFA) scores between the two groups before treatment (P>0.05). After treatment, alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), serum creatinine (Scr), prothrombin time (PT), prothrombin activity (PA), total bilirubin (TBil) Direct bilirubin (DBil), creatine kinase isoenzymes (CKMB), partial pressure of carbon dioxide (PaCO₂), alveolar arterial oxygen pressure difference (P (A-a) O₂), MODS and SOFA scores in the two groups were significantly lower than those before treatment (P<0.05). However, PH value, partial pressure of oxygen (PaO₂), bicarbonate ( {\mathrm{HCO}}_3^{-}) and oxygenation index (PaO₂/FiO₂, P/F) were higher than those before treatment, and HP+CRRT group improved more significantly than HP group (P<0.05). The total mortality rate of 56 patients was 44.64%, which was higher in HP group than HP+CRRT group. Meanwhile, the survival curve showed that the survival rate of HP+CRRT group was obviously higher (P<0.05). Conclusion The combination of HP and CRRT can alleviate organ damage and reduce the mortality of PQ patients with MODS, making it an effective treatment therapy.

Predictive value of augmented renal clearance on the therapeutic efficacy of cefoperazone sodium/sulbactam sodium injections in elderly patients in intensive care unit

Wang Youfang, Li Xingchao, Zhu Xiaosong, Zhou Tingfa, Zhang Jianguo, Yang Shuhong, Xiang Ran, Zhang Mengmeng, Che Fengyuan

2023, 38(4):  335-339.  doi:10.3969/j.issn.1004-583X.2023.04.008

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Objective To explore the predictive value of augmented renal clearance (ARC) on the therapeutic efficacy of cefoperazone sodium/sulbactam sodium injections in elderly patients in intensive care unit (ICU), thus providing theoretical reference for clinical diagnosis and treatment. Methods A total of 528 elderly patients admitted to the Intensive Care Department of Linyi People's Hospital from January 2020 to December 2021 were selected and allocated to ARC group (n=106) and non-ARC group (n=422) based on the occurrence of ARC. Baseline characteristics, deep steady-state trough concentration of cefoperazone sodium/sulbactam sodium (measured the efficacy of cefoperazone sodium/sulbactam sodium on half an hour before the medication) were collected and compared. Univariable and multivariable logistic regression analyses were performed to identify risk factors for the therapeutic efficacy of cefoperazone sodium/sulbactam sodium on elderly patients in ICU, and the predictive value on the efficacy was assessed by plotting the receiver operating characteristic curve. Results The incidence of ARC in this study was 20.1%. There were no significant differences in sex, body mass index (BMI), total protein, albumin, globulin, albumin/globulin ratio, alanine aminotransferase, total bilirubin, and uric acid between the two groups (P>0.05). Compared with those of the non-ARC group, patients in the ARC group were significantly younger with significantly lower blood urea nitrogen and creatinine, and higher creatinine clearance rate (CCr) and glomerular filtration rate (GFR)(P<0.05). There were significant differences in the deep steady-state trough concentration of cefoperazone sodium/sulbactam sodium and clinical outcomes between groups (P<0.05). Compared with those of the non-ARC group, patients in the ARC group had a significantly longer length of stay and higher mortality (P<0.05). Multivariate logistic regression analysis showed that ARC, age, blood urea nitrogen, creatinine, CCr, and GFR were all independent risk factors for the efficacy of cefoperazone sodium/sulbactam sodium injections on elderly patients in ICU (P<0.05). The receiver characteristic curve showed that the area under the curve of ARC predicting the efficacy of cefoperazone sodium/sulbactam sodium injections in elderly ICU patients was 0.828, with a sensitivity of 89.69% and a specificity of 78.28%.Conclusion ARC has a good predictive value for the efficacy of cefoperazone sodium/sulbactam sodium injections on elderly patients in ICU.

Risk factors of postoperative venous thromboembolism in patients with multiple myeloma

Leng Wantong, Tao Jie

2023, 38(4):  340-345.  doi:10.3969/j.issn.1004-583X.2023.04.009

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Objective To analyze risk factors of postoperative venous thromboembolism (VTE) in multiple myeloma (MM) patients. Methods One hundred and fifty seven MM patients initially treated in the Department of Hematology, the First Hospital of Shanxi Medical University from January 2012 to January 2022 were enrolled. Patients were assigned to the non-VTE group (n=124) and VTE group (n=33) based on the existence of VTE. Clinical data of the two groups were compared, and risk factors for VTE in MM patients after treatment were analyzed. Results The results of univariate analysis showed that the age, recent surgical history, recent fracture history, D-dimer>0.55 mg/L, use of immunomodulatory drugs, and IMPEDE score ≥8 points were related to the occurrence of VTE in MM patients after treatment (P<0.05). Binary multivariate logistic analysis showed that the age, recent surgical history, D-dimer >0.55 mg/L, and use of immunomodulatory drugs were the risk factors for the occurrence of VTE in MM patients.Conclusion The assessment of the risk of VTE in MM patients after treatment should be comprehensively combined with the patient's age, medical history, laboratory indicators and treatment plan. In view of the fact that the relevant score for MM patients in foreign countries may not be fully applicable to the Chinese population, further research is needed to develop the risk score for VTE in Chinese MM patients and verify it.

Prognostic value of procalcitonin to platelet ratio in patients with fever with thrombocytopenia syndrome

Yang Jinqiang, Zhang Renmin

2023, 38(4):  346-351.  doi:10.3969/j.issn.1004-583X.2023.04.010

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Objective To investigate the value of procalcitonin/platelet ratio(PCT/PLT) in evaluating the prognosis of Severe fever with thrombocytopenia syndrome(SFTS). Methods A total of 156 SFTS patients diagnosed in Weihai Central Hospital from January 1, 2020 to January 1, 2022 were collected andassigned into death group and survival group according to the prognosis. the basic data and laboratory indicators of the two groups were compared, the independent risk factors affecting the prognosis of SFTS were screened by univariate and binomial multiple Logistic regression, and the value of different influencing factors on the prognosis of SFTS was evaluated by the area under the receiver operating characteristic(ROC) curve, sensitivity, specificity, accuracy.Results Activated partial thromboplastin time, thrombin time, D-dimer, alanine aminotransferase, serum creatinine, lactate dehydrogenase, aspartate aminotransferase, blood urea nitrogen, activated partial thromboplastin time/platelet, neutrophil count, neutrophil lymphocyte ratio, creatine kinase isoenzyme, procalcitonin, PCT/PLT, as well as the proportion of patients whose nucleic acid quantity were higher than the optimal reference value in the death group was significantly higher than those in the survival group(P<0.05). The proportion of patients with Ca²⁺, PLT, lymphocyte count higher than the optimal reference value was significantly lower than that in the survival group(P<0.05). Univariate and binomial multiple Logistic regression showed that age, thrombin time, aspartate aminotransferase, lymphocyte count, PCT/PLT, and viral nucleic acid quantification were independent risk factors for the prognosis of SFTS. The best reference value of PCT/PLT was 0.005, and the AUC was 0.828(0.757-0.898). When PCT/PLT was greater than 0.005, the risk of death was increased by 30 times, the sensitivity was 87.1%, and the specificity was 78.4%. Conclusion PCT/PLT can be used as a clinical indicator to evaluate the prognosis of patients with SFTS.

Acquired immune deficiency syndrome complicated with severe pneumonia: A case report and literature review

Zhou Dawei, Fei Changdong, Liu Yupeng, Zhang Hualin

2023, 38(4):  352-355.  doi:10.3969/j.issn.1004-583X.2023.04.011

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Objective To explore the comprehensive effect of empirical drugs combination in acquired immune deficiency syndrome (AIDS) patients with severe pneumonia opportunistic infection. Methods The one AIDS patients with severe pneumonia admitted to 967 Hospital of the Joint Logistics Support Force of PLA was retrospectively analyzed. The literature review was assessed.Results For the middle-aged men, the history of HIV/AIDS infection were nearly two years, the patient was admitted to hospital due to the weight loss for half a year, 1 month fever cough, increase breathing difficulties with 3 days. After hospitalization, the diagnosis was confirmed: ① severe pneumonia ② TypeⅠ respiratory failure ③ AIDS.The patient was carried out endotracheal intubation and ventilator breathing, with antibiotic therapy, and had enteral nutrition therapy after discharged, 2 months later on court appointment without symptoms of fever, cough, sputum, Reexamination of chest CT showed localized emphysema in the middle lobe of the right lung, absorption of double pneumonia, normal liver function and renal function. Conclusion For AIDS patient with severe pneumonia, the empirical drugs combination plays a key role on the patient's condition without etiological evidence. Ventilator support treatment and pulmonary protective ventilation are better protect and improve lung function, enteral nutrition treatment may contributed to the successful treatment.

One case of missed diagnosis of multiple organ dysfunction syndrome complicated with adrenal crisis and literature review

Gao Weikang, Quan Jianhua, Niu Xinrong

2023, 38(4):  356-358.  doi:10.3969/j.issn.1004-583X.2023.04.012

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Objective To discuss the clinical features, diagnosis and treatment points, and causes of misdiagnosis and missed diagnosis of multiple organ dysfunction syndrome (MODS) complicated with adrenal crisis (AC). Methods A retrospective analysis was conducted on the medical records of one case of missed diagnosis of MODS complicated with AC.Results A 48-year-old male patient was admitted to hospital with vomiting and diarrhea for 2 days, drowsiness for 1 day and loss of consciousness for 10 minutes. Due to high fever, low blood pressure, high pro-calcitonin and lactic acid, combined with abnormal liver and kidney function and coagulation function, the patient was diagnosed as intestinal infection with septic shock and MODS. Symptomatic supportive treatment including anti-infection, organ support, and maintaining internal environment stability was actively given. However, there was no significant improvement in the degree of shock and consciousness disorder compared with admission. After repeatedly asking about the medical history, the family members complained that the patient was in good health in the past, and then a physical examination was given again. It was found that the patient's whole body skin was dark, except for work reasons, it was considered that this situation was caused by endocrine system diseases. After examining the hormone levels, the patient was diagnosed as AC, and 2.5 mg of prednisolone acetate was given orally once a day. The dosage of prednisolone acetate was adjusted based on the rechecked hormone levels, and the symptoms were quickly corrected. Conclusion For healthy population without underlying diseases, the early clinical features of AC are often manifested as respiratory tract, digestive tract and neurological symptoms, which are prone to miss diagnosis and misdiagnosis. Doctors should strengthen the understanding of this disease, provide early treatment with glucocorticoid, identify the cause of AC, and give active treatment.

Rare adrenal neurofibroma: A case report and literature review

Luo Jie, Wu Qiang, Li Zhong, Zheng Shuo

2023, 38(4):  359-363.  doi:10.3969/j.issn.1004-583X.2023.04.013

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Objective To analyze the clinical features of adrenal neurofibroma (ANF) and improve the understanding of its diagnosis and treatment techniques. Methods The clinical data, diagnosis and treatment process, and follow-up results of one pathologically confirmed ANF case admitted to our hospital were analyzed. Combined with published domestic and foreign literature review, case report was summarized. Results In this case, preoperative examination of relevant adrenal hormone levels was normal, and enhanced CT revealed a space occupying lesion in the right adrenal gland, indicating a benign neoplastic lesion. Posterior laparoscopic surgery was performed to remove the adrenal mass and a small portion of the right adrenal gland. Postoperative pathology showed a piece of grayish-yellow grayish-red tissue, with a size of 6.5 cm×5.5 cm×4.0 cm. The capsule was visible, with multiple nodular shapes on the section. The gray white solid was soft, the local nodules were hard, and a little adrenal tissue could be seen. Light microscopy showed spindle cell tumor, nerve fiber endings, and interstitial mucinous degeneration. No abnormal nuclear division or cell atypia was observed. Combined with immunohistochemistry, ANF was obtained. After one month of follow-up after operation, the levels of adrenal related hormones were normal, and there was no recurrence or metastasis. Conclusion ANF is a benign tumor with lack of specificity in clinical symptoms and signs. Preoperative laboratory and imaging examination cannot confirm the diagnosis, and the diagnosis depends on histopathology. Laparoscopic complete tumor resection is the key to treatment, and retroperitoneal approach has more advantages. Most of the cases have good prognosis, but close observation and follow-up are needed.