原发性腹膜后肾上腺外嗜铬细胞瘤17例的诊断与外科治疗  

Primary retroperitoneal extraadrenal pheochromocytoma

作　　者：杨维良[1] 闫朝岐[1] 王夫景[1] 张浩民[2] 王惠良 

机构地区：[1]哈尔滨医科大学附属第二医院普外科,150086 [2]齐齐哈尔医学院附属第二医院普外科 [3]牡丹江市第二医院普外科

出　　处：《中华普通外科杂志》2009年第7期558-560,共3页Chinese Journal of General Surgery

摘　　要：目的探讨原发性腹膜后肾上腺外嗜铬细胞瘤（PREAP）的诊断与外科治疗经验。方法回顾性分析1976-2006年治疗的17例PREAP的临床资料。结果根据17例的临床表现兼有嗜铬细胞瘤的阵发性或持续性阵发加剧高血压和原发性腹膜后肿瘤解剖位置较深、范围广、肿瘤大、易侵及邻近脏器的特点，BUS是定位诊断初步筛选的重要方法；CT和MRI对PREAP可精确定位，尤其是MRI在病灶定位及软组织分辨率方面优于CT；24h尿儿茶酚胺平均含量可高达526．1μg，VMA阳性率可达92．3％以上；^129I-MIBG用于PREAP定位优于^131I-MIBG。可PREAP定位或定性诊断率达97％～100％，本组术前13例确诊PREAP，4例疑诊PREAP。15例完整切除肿瘤，其中2例因为在70年代对儿茶酚胺心肌病变认识不足，术前准备不充分，术中死亡；对80年代及以后手术的13例，由于提高了对PREAP的认识，术前准备充分，术中血压控制稳定，术后无并发症，治愈。2例巨大肿瘤行包膜内肿瘤剜除并用银夹标记部位，便于肿瘤复发后处理。结论应重视PREAP术前定性、定位诊断，手术是治疗PREAP的最佳方法，充分术前准备是手术成功的关键。Objective To evaluate the diagnosis and surgical treatment of primary retroperitoneal extraadrenal pheochromocytoma（PREAP）. Methods Clinical data of 17 cases with PREAP from 1976 to 2006 were analyzed retrospectively. Results It was not difficult for the diagnosis of PREAP based on the primary symptoms, including paroxysmal hypertension or persistent hypertension. PREAP is usually deep, large and invading on adjacent organs. B-ultrasound was used for preliminary screening. CT and MRI with high soft tissue resolution and multi directional imaging are of great value for correct diagnosis and determination of exact extent of the tumor in diagnosis of PREAP. 24 h urinary VMA output imcreased in 12 cases （92. 3% ） and urinary catecholamine level was up to 526. 1μg. Precise location of PREAP by ^123I-MIBG is superior to that by ^131I-MIBG. The diagnosis was tentative in 4 cases and definite in 13 cases. Complete tumor resection was achieved in 15 cases, among them 2 cases died on table due to inadequate preparation before surgery in 1970＇s. In the remaining 2 cases with huge tumors partial resection, silver clips were put in during operation to locate the extent of the tumors for further management after operation. Conclusions Locating and qualitative diagnosis before operation are valuable and once the patients are diagnosed as PREAP, they should receive exploratory laparotomy after an adequate preparation.

关 键 词：腹膜后肿瘤 嗜铬细胞瘤 外科手术 

分 类 号：R686[医药卫生—骨科学]