异位腹主动脉旁嗜铬细胞瘤诊疗体会  

Diagnosis and treatment experience of ectopic para-aortic pheochromocytoma

作　　者：韦家冬[1] 叶志强[1] 徐义春[2] 方和平[3] 潘楚芝[3] 邬杰忠 邓美海[3] 

机构地区：[1]中山大学附属第三医院急诊外科,广州510630 [2]中山大学附属第三医院岭南医院骨科,广州510530 [3]中山大学附属第三医院肝胆外科,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2015年第1期38-41,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省自然科学基金(S2013010016015);广州市科技计划项目(2013J4100061)

摘　　要：目的探讨异位腹主动脉旁嗜铬细胞瘤的诊断与治疗。方法回顾性分析2012年8月至2013年12月中山大学附属第三医院收治的两例异位腹主动脉旁嗜铬细胞瘤患者临床资料。所有患者均签署知情同意书,符合医学伦理学规定。患者均为女性,年龄分别为54、57岁。观察两例患者的发病情况、诊断、治疗及疗效。结果例1患者因上腹胀痛1月余,发现腹膜后占位性病变8 d入院。腹部超声及CT检查示右侧中上腹部实性占位性病变。术前诊断:腹部间质瘤。例2患者因心悸、胸痛,发现肝占位性病变10 d入院。既往有高血压病史5年。上腹部超声、CT、MRI检查示肝尾状叶囊实性占位性病变,考虑囊腺瘤可能。两例患者在气管插管全身麻醉下行腹主动脉旁嗜铬细胞瘤切除术。术中探查触摸肿瘤对患者血压、心率影响很大,诊断为腹主动脉旁嗜铬细胞瘤。术后转外科ICU监护、治疗。病理学检查确诊为嗜铬细胞瘤。术后患者痊愈出院,截止至投稿日期患者恢复良好。结论异位腹主动脉旁嗜铬细胞瘤是一种罕见病,无特异性临床表现,术前诊断困难,确诊依靠病理学检查,治疗方式首选手术切除。术前充分评估手术风险,术中注意尽量避免触碰瘤体组织,完整切除肿瘤包膜,术后密切观察血压变化等情况,可获得良好的临床治疗效果。Objective To investigate the diagnosis and treatment of ectopic para-aortic pheochromocytoma. Methods Clinical data of 2 cases with ectopic para-aortic pheochromocytoma in the Third Affiliated Hospital of Sun Yat-sen University from August 2012 to December 2013 were analyzed retrospectively. The informed consents of both patients were obtained and local ethical committee approval had been received. Both patients were female with the age of 54, 57 years old. The occurrence of disease, diagnosis, treatments and efficacy were observed. Results Case 1 was admitted in hospital for complaint of 1-month distending pain in upper abdominal and finding of retroperitoneal space-occupying lesion for 8 d. Solid space-occupying lesion at the right side of mid-upper abdomen was found by abdominal ultrasound andcomputer tomography（CT） examination. The preoperative diagnosis was abdominal mesenchymoma. Case 2 was admitted in hospital for complaint of palpitation, chest pain and finding of hepatic space-occupying lesion for 10 d and had a history of 5-year hypertension. Cystic solid space-occupying lesion in the hepatic caudate lobe was found by abdominal ultrasound, CT and magnetic resonance imaging（MRI） examinations and cystadenoma was suspected. The 2 patients underwent resection of ectopic para-aortic pheochromocytoma under general anesthesia by tracheal intubation. The intraoperative exploration found that touching the tumor had great impacts on blood pressure and heart rate and ectopic para-aortic pheochromocytoma was diagnosed. The patients were transferred to surgical intensive care unit（ICU） for monitoring and treatment. Pheochromocytoma was confirmed by the pathological examination. The patients were recovered and discharged from hospital and remained well till the paper submission date. Conclusions Ectopic para-aortic pheochromocytoma is a rare disease without characteristic clinical features. It is difficult for preoperative diagnosis. The confirmation is mainly depends on the pathological findings. Surgica

关 键 词：嗜铬细胞瘤 副肿瘤内分泌综合征 主动脉 腹 外科手术 

分 类 号：R736.6[医药卫生—肿瘤] R657.3[医药卫生—临床医学]