肾上腺功能隐匿性嗜铬细胞瘤的诊治体会(附12例报告)  

Diagnosis and treatment of adrenal hidden functional pheochromacytoma:experience on 12 cases

作　　者：芮文斌[1] 沈周俊[1] 祝宇[1] 吴瑜璇[1] 周文龙[1] 邵远[1] 谢欣[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院泌尿外科,200025

出　　处：《上海医学》2009年第2期115-116,共2页Shanghai Medical Journal

摘　　要：目的探讨如何提高肾上腺功能隐匿性嗜铬细胞瘤的诊断意识和手术安全性。方法肾上腺功能隐匿性嗜铬细胞瘤患者12例,术前均行内分泌检查、常规B超及CT检查。除两例肿瘤直径≤5cm的患者术前未服用α受体阻滞剂(甲磺酸多沙唑嗪控释片)外,其他均以4mg/d的剂量口服1～3周。严格按嗜铬细胞瘤进行麻醉准备,术中尽量减少肿瘤挤压,尽早控制中央静脉,主要操作及时告知麻醉师,术后严密监测,及时纠正低血压。结果12例肿瘤均完整切除,病理检查证实为嗜铬细胞瘤。术中均发生血压波动,最高升至170/100mmHg(1mmHg=0.133kPa),发生在触及或挤压肿瘤时。术后仅1例术前未服用α受体阻滞剂的患者出现低血压,予去甲肾上腺素静脉微量泵推注,术后24h内血压纠正撤退。结论提高功能隐匿性嗜铬细胞瘤的诊断意识以及严格的围术期准备是保障其手术安全性的关键。Objective To improve the diagnosis and surgical treatment safety of patients with adrenal hidden functional pheochromocytoma （AHFP）. Methods Twelve AHFP patients were admitted to the Department of Urology of our hospital from May 2003 to October 2008. All the patients underwent endocrinology examination, B ultrasound and CT examinations. Two patients with a tumor diameter 45 cm did not take blocker of a receptor （Dosazoxin）;all the other patients received a regimen of 4 mg/d for 1--3 weeks. Anesthesia was prepared as requested for pheochromocytoma. During operation, we avoided any unnecessary press of the tumor. The central vein should be cohtrolled early and the anesthetist should be informed of the major procedures. Close monitor should be done after operation. Low blood pressure should be corrected timely. Results The operations were successfully performed in all the 12 patients, and all were confirmed of pheochromocytoma pathologically. Fluctuation of blood pressure was observed in all patients during operation, with the peak pressure being 170/ 100 mmHg（ 1 mmHg=0. 133 kPa）, all occurring when touching or pressing the tumors. Postoperatively only one patient who took Doxazosine had low blood pressure, which was corrected by intravenous bonus of norepinephrine 24 h after operation. Conclusion A better diagnosis consciousness and adequate perioperative preparation are keys for the surgical safety of patients with adrenal hidden functional pheochromocytoma. （Shanghai Med J,2009,32：115-116）

关 键 词：嗜铬细胞瘤 诊断 治疗 

分 类 号：R736.6[医药卫生—肿瘤]