摘要
目的 提高儿茶酚胺症的诊断和治疗水平。 方法 报告 182例儿茶酚胺症患者的临床资料 ,其中嗜铬细胞瘤 173例 ,髓质增生 9例。临床表现为阵发性高血压 10 3例 (5 7% ) ,持续性高血压 6 9例 (38% ) ,血压正常 10例 (5 % )。 15 9例行尿VMA检查 ,异常 15 0例 (94% )。腹膜后充气造影 5 3例 ,阳性 46例 (87% ) ;B超检查 146例 ,阳性 133例 (91% ) ;CT检查 10 9例 ,阳性 10 3例 (95 % ) ;MRI检查 2 2例 ,均为阳性。 结果 182例均行手术治疗并经病理证实 ,良性 16 3例 (90 % ) ,恶性 19例 (10 % ) ;肿瘤位于肾上腺 15 1例 (83% ) ,异位嗜铬细胞瘤 2 2例 (12 % ) ,肾上腺髓质增生 9例 (5 % )。16 5例随访 1～ 2 4年 ,19例恶性嗜铬细胞瘤均死亡 ,余 146例中 12 9例 (88% )术后无需药物治疗 ,血压恢复正常。 17例 (12 % )术后仍需持续用药控制血压 ,其中多发性肿瘤 7例 ,肾上腺外肿瘤 4例 ,非儿茶酚胺依赖性高血压 6例。 结论 尿VMA检查是儿茶酚胺症定性诊断的主要依据 ,B超、CT、MRI检查为定位诊断的主要依据。根本治疗方法为手术切除 ,充分的术前准备和正确的围手术期处理十分重要。
Objective To evaluate the diagnosis and treatment of catecholamine syndrome. Methods 182 cases of catecholamine syndrome diagnosed and treated between 1970 to 1999 were reviewed and studied.94% of these cases manifested hypertension.VMA,serum and urinary catecholamine were studied showing good sensitivity.Urinary VMA assay was specific and essential for diagnosis,the positive sensitivity being 94%. The accurate rate of localization and diagnosis with B-ultrasonography, CT and MRI was 91%,95% and 100% for adrenal pheochromocytoma. Preoperative preparation with α adrenergic blocker for hypertension and β adrenergic blocker against arrhythmias were essential. Results 182 cases of catecholamine syndrome were comfired by surgery and pathology.151 cases (83%) were adrenal pheochromocytoma,22 cases (12%) being extraadrenal pheochromocytoma and 9 cases (5%) adrenal medullary hyperplasia (AMH).163 cases (90%) were benign and the others 19(10%) were malignant.The extradrenal pheochromocytoma was oftern multiple,recurrent with a high tendency to malignancy. Conclusions Surgical extirpation was the only means of cure and meticulous preoperative preparation was essential.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2001年第4期200-202,共3页
Chinese Journal of Urology
