无症状肾上腺嗜铬细胞瘤33例诊治分析  

Analysis of diagnosis and treatment on asymptomatic adrenal pheochromocytoma of 33 cases

作　　者：毕建斌[1] 孙嘉伟[1] 陈雪磊[1] 李炳勋[1] 宫大鑫[1] 刘涛[1] 孔垂泽[1] 

机构地区：[1]中国医科大学附属第一医院泌尿外科,沈阳110001

出　　处：《中国医师进修杂志》2010年第26期21-23,共3页Chinese Journal of Postgraduates of Medicine

基　　金：辽宁省自然科学基金（20082094）

摘　　要：目的提高无症状肾上腺嗜铬细胞瘤的诊断和治疗水平。方法回顾性分析33例无症状肾上腺嗜铬细胞瘤患者的临床资料。结果33例无症状肾上腺嗜铬细胞瘤患者均无典型嗜铬细胞瘤的临床表现。超声及CT检查多表现为轮廓较清晰的囊实性肿物，中央有低密度区或坏死区，周边实质部分可见不均匀强化。血浆肾上腺素及去甲肾上腺素均升高者5例（16％，5／31），尿中儿茶酚胺（CA）升高者6例（24％，6／25），尿香草扁桃酸（VMA）升高者5例（20％，5／25）；26例术前怀疑嗜铬细胞瘤的患者给予降压及扩容治疗；32例成功手术切除肿瘤，探查取病理术l例；所有病例均经术后病理证实为嗜铬细胞瘤。所有病例随访1个月至7年，无肿瘤复发。结论无症状肾上腺嗜铬细胞瘤患者CA及其代谢产物水平较低，为定性诊断带来困难。影像学检查对无症状肾上腺嗜铬细胞瘤的诊断有较大帮助；对于瘤体较大、无症状的。肾上腺肿瘤，术前也应按嗜铬细胞瘤常规作药物准备，以减少手术危险性。Objective To improve the diagnosis and treatment of asymptomatic adrenal pheochromocytoma. Method The clinical data of 33 patients with asymptomatic adrenal pheochromocytoma were reviewed. Results All the patients were not present with typical signs and symptoms of pheochromocytoma, 16 patients were found adrenal mass by routine physical examination, 15 patients presented with superior abdominal or flank pain, 1 patient was fever and 1 patient was diarrhea. Most of patients were present with round mass with low density in the center of the tumor,5 patients had elevated level of plasma epinephrine and norepinephrine （16% ,5/31 ）,24 hours urine CA and VMA were elevated in 6 patients （24% ,6/25） and 5 patients （20% ,5/25） respectively, 26 patients who were suspected pheochromocytoma preoperatively were treated with α-adrenergie blockade （prazosin） to control the blood pressure or with intravenous colloid fluids and blood transfusion to expand intravascular volume before operation. The tumors were removed successfully in 32 patients, and biopsy was done in 1 patient because of the serious invasion to the vena cava by the tumor. All the patients were diagnosed pheochmmocytoma histopathologieally, and followed up for 1 month to 7 years, no tumor recurrence. Conclusions The patients with asymptomatie adrenal pheochromocytoma have lower catecholamine excretion in their plasma and urine. Combination of modem, imaging examinations are useful methods to diagnose asymptomatic adrenal pheochromocytoma. To lower the risk of operation, the control of blood pressure and the expanding of intravascular volume are important for the patients with huge adrenal mass or typical suspected appearance of pheochromocytoma.

关 键 词：肾上腺 嗜铬细胞瘤 诊断 治疗 无症状 

分 类 号：R736.6[医药卫生—肿瘤]