肾上腺外嗜铬细胞瘤的诊断与治疗  被引量:8

The diagnosis and treatment of extra-adrenal pheochromocytoma

在线阅读下载全文

作  者:王先进[1] 沈周俊[1] 吴瑜璇[1] 周文龙[1] 祝宇[1] 孙福康[1] 钟山[1] 张荣明[1] 张存明[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:《中华泌尿外科杂志》2011年第5期295-298,共4页Chinese Journal of Urology

摘  要:目的探讨肾上腺外嗜铬细胞瘤(EAP)的诊断和治疗经验。方法回顾性分析2003年4月至2010年4月收治的37例EAP患者的资料。临床表现为高血压31例,典型的头痛、心悸、多汗“三联征”12例。血浆游离变肾上腺素类物质(MNs)和24h尿儿茶酚胺(CA)定性诊断的阳性率分别为96.8%(30/31)和86.5%(32/37)。超声、CT、MRI和^131Ⅰ-间碘苄胍扫描(^131Ⅰ-MIBG)定位诊断的准确率分别为91.7%(33/36)、97.0%(32/33)、90.o%(9/10)和82.6%(19/23)。35例行手术治疗,2例行放射治疗。结果单发肿瘤32例,其中腹主动脉旁14例、膀胱内7例、下腔静脉旁4例、肾门附近4例、髂血管旁2例、肾上极1例;多发肿瘤5例。完整切除肿瘤30例,行肿瘤切除+右肾切除3例,行膀胱部分切除2例。病理诊断良性24例,恶性11例。术前31例高血压患者中,术后23例血压恢复正常,6例血压降低但仍高于正常,2例血压无明显变化。术后34例随访5个月~7年,肿瘤复发5例,死亡5例。结论EAP少见,血浆游离MNs和24h尿cA是重要的定性诊断方法。定位诊断较困难,超声、CT、MRI和^131Ⅰ-MIBG是重要的定位诊断方法。经腹途径切除肿瘤是首选的治疗方法,充分术前准备,术中避免过度挤压肿瘤。对于恶性者术后可辅以^131Ⅰ-MIBG治疗。Objective To investigate the diagnosis and treatment of extra-adrenal pheochromocytoma (EAP). Methods The clinical data of 37 cases of EAP from April 2003 to April 2010 were retrospectively analyzed. Hypertension was observed in 31 cases. The typical triad of headache, palpitation and sweating was observed in 12 cases. The positive rate of plasma free MNs and 24-hour urinary CA in diagnosing EAP was 96.8% (30/31) and 86.5% (32/37) respectively. The main localiza tion diagnosis included ultrasonography, CT, MRI and ^131Ⅰ-MIBG, with positive rates of 91. 70% (33/36), 97.0% (32/33), 90% (9/10) and 82.6% (19/23) respectively. Two patients underwent radiotherapy, and the remaining 35 cases underwent surgical treatment. Results Among the total of 37 cases, 32 cases were single tumor, and five were multiple tumors. The anatomic locations of the single tumors were as follows, 14 wre adjacent to the abdominal aorta, seven in the bladder, four ad jacent to the inferior vena cava, four adjacent to the renal hilum, two adjacent to the iliac blood vessel and one in the upper pole of the right kidney. Thirty cases underwent complete tumor resection,three cases underwent tumor resection plus right nephrectomy and two cases underwent partial cystectomy. Twenty-four cases were diagnosed benign and 11 cases were diagnosed malignant by pathological examination. Among 31 cases with preoperative hypertension, postoperative blood pressure returned to normal in 23 patients, blood pressure descended mildly in six cases and blood pressure was still hypertensive in two cases. Thirty four patients were followed up for five months to seven years, during which five cases had tumor recurrence or metastases and five cases died postoperatively. Conclusions EAP is a rare neuroendocrine tumor and its accurate diagnosis is rather difficult. Plasma-free MNs and 24-hour urinary CA are important qualitative examinations. Ultrasonography, CT, MRI and ^131Ⅰ- MIBG scintigraphy are important methods for the localization o

关 键 词:嗜铬细胞瘤 肾上腺外 诊断 治疗 

分 类 号:R736.6[医药卫生—肿瘤]

 

参考文献:

正在载入数据...

 

二级参考文献:

正在载入数据...

 

耦合文献:

正在载入数据...

 

引证文献:

正在载入数据...

 

二级引证文献:

正在载入数据...

 

同被引文献:

正在载入数据...

 

相关期刊文献:

正在载入数据...

相关的主题
相关的作者对象
相关的机构对象