摘要
目的提高血压正常的肾上腺嗜铬细胞瘤的诊治水平。方法回顾性分析22例正常血压的肾上腺嗜铬细胞瘤患者资料。男9例，女13例。平均年龄42岁。既往均无高血压病史和高血压临床表现，入院时血压90～130／60～90mmHg（1mmHg-0．133kPa），平均113／72mmHg。其中无症状体检B超发现肾上腺肿瘤7例，腰腹部疼痛不适12例，乏力4例，发热2例，头晕、心悸1例。B超及CT检查见肾上腺轮廓较清晰的囊实性肿物，中央有液化坏死区，周边实性部分可见不均匀强化。肾上腺素及去甲肾上腺素升高19％（14／21）、尿儿茶酚胺升高28％（5／18）、香草基扁桃酸升高22％（4／18）。术前拟诊为无功能肾上腺皮质腺瘤3例、腹膜后肿瘤1例、肾上腺嗜铬细胞瘤18例。术前予扩容治疗7例，其中同时给予哌唑嗪治疗2例。结果22例均行手术治疗。术中出现血压波动17例，给予盐酸乌拉地尔、酚妥拉明等控制血压，输血补液、去甲肾上腺素处理低血压。7例经术前扩容治疗患者术中出现血压明显波动1例，15例术前未经扩容患者术中出现血压明显波动11例。21例手术成功切除肿瘤，探查仅取活检1例。22例均经病理证实为嗜铬细胞瘤。21例随访1个月～7年，手术切除肿瘤患者均无复发，血压正常平稳。结论血压正常的嗜铬细胞瘤患者儿茶酚胺及其代谢产物水平较低，定性诊断困难，典型的影像学表现对诊断有较大帮助；血压正常的嗜铬细胞瘤患者术前也应常规应用α受体阻滞剂和扩容治疗，可以降低手术风险、减少并发症。
Objective To discuss the diagnosis and treatment of normotensive pheochromocytoma. Methods The clinical data of 22 patients with normotensive pheochromocytoma were reviewed. Inclusion criteria for normotensive pheochromocytoma were no previous history of hypertension and episode of symptoms suggesting high blood pressure. The blood pressure on admission was 90--130/ 60--90 mm Hg with an average of 113/72 mm Hg. Seven patients were found adrenal mass by routine ultrasonic examination. Twelve patients presented with superior abdominal or flank pain. Four patients were present with fatigue, and 2 patients had fever. Headache and palpitation were found in 1 patient. Most of patients were present with large and round mass with low density area in the center of the tumor by ultrosonography and CT. Four patients had elevated level of plasma epinephrine and norepinephrine. 24 hours urine CA and VMA were elevated in 5 and 4 patients respectively. Seven pa- tients were prepared with infusion preoperatively to expand intravascular volume, and 2 patients were given prazosin 1.5 mg/d for 5 to 7 days. Results During the operation, seventeen patients had ele- vated blood pressure and 5 patients had no changed. One of seven patients with preoperative preparation had obvious hypertension during operation, and 11 of 15 patients without preoperative preparation had obvious hypertension. The tumors were removed successfully in 21 patients. All the patients were diagnosed pheochromocytoma pathologically. Twenty-one patients had normal blood pressure with no recurrence during the follow-up from 1 month to 7 years. Conclusions The patients with normotensive pheochromocytomas may have lower catecholamine in their plasma and urine. The application of α-blockers and the expanding intravascular volume before operation could be important for the patients safe.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2009年第2期77-80,共4页
Chinese Journal of Urology
关键词
肾上腺肿瘤
嗜铬细胞瘤
血压正常
围手术期医护
Adrenal gland neoplasmas
Pheochromocytoma
Normal blood pressure
Perioperative care
