心脏嗜铬细胞瘤的诊断及外科治疗(附3例报告)  

Diagnosis and Surgical Treatment of Cardiac Pheochromocytoma:a Report of 3 Cases

作　　者：张超纪[1] 苗齐[1] 刘兴荣[1] 曾正培[1] 李汉忠[1] 罗爱伦[1] 张抒扬[1] 

机构地区：[1]中国医学科学院北京协和医院心外科,北京市100730

出　　处：《中国肿瘤临床》2008年第16期908-909,913,共3页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨心脏嗜铬细胞瘤的诊断与外科治疗。方法:心脏嗜铬细胞瘤3例,男性2例,女性1例,年龄分别为l7、19及35岁。患者均以头痛、心悸、大汗及血压增高就诊。术前24小时尿儿茶酚胺检查均升高,分别经超声心动、CT及冠脉造影等检查证实心脏不同部位有占位性病变,3例生长抑素受体显像阳性。3例均在体外循环下行肿瘤切除术。结果:手术顺利,无手术死亡,术后病理证实为心脏嗜铬细胞瘤。术后随访28～48个月患者头痛、心悸、大汗及高血压明显改善。1例术后原心脏部位生长抑素受体高表达病灶有进展,1例24小时尿儿茶酚胺水平未降至正常水平。结论:心脏嗜铬细胞瘤极为罕见,诊断过程困难,手术切除肿瘤是治疗心脏嗜铬细胞瘤有效的方法,对不能手术直接切除的心脏嗜铬细胞瘤患者,自体心脏移植是一种值得考虑的手术选择。Objective： To investigate the diagnosis and surgical treatment of cardiac pheochromocytoma. Methods： We analyzed the clinical data of 3 cases （2 males and 1 female） of cardiac pheochromocytoma who were 17, 19 and 35 years old. They all presented with headache, sweating, palpitation and hypertension. The preopera- tive 24-hour urinary catecholamine excretion was significantly raised. Masses were observed on CT, MRI, coronary arterography and so on. All 3 patients had positive results with Te-99m-Otretide Scintigraphy （HTOC） and underwent orthotopic excision of tumors under cardiopulmonary bypass. Results： The quality of life for these 3 patients was satisfactory dudng follow-up （28-48 months）. Instances of headache, sweating, palpitation and hypertension decreased. Postoperative pathology confirmed the diagnosis of cardiac pheochromocytoma. Follow-up revealed that the 17-year old patient had positive results with HTOC, and the 35-year old patient had a higher level of 24-hour urinary catecholamine excretion than normal. Conclusion： Cardiac pheochromocytoma is a rare tumor and its diagnosis and surgical treatment are rather difficult and complex. Surgical excision is an effective treatment for cardiac pheochromocytoma and heart transplantation may be a therapeutic option in selected patients when the tumor cannot be resected.

关 键 词：嗜铬细胞瘤 心脏 手术治疗 

分 类 号：R732.1[医药卫生—肿瘤] R736.6[医药卫生—临床医学]