嗜铬细胞瘤术前CT影像学参数与围手术期参数的相关性研究  

The pre-operative CT parameters and perioperative manangement of pheochromocytoma

作　　者：马文明 李强[2] 卓然 冒永鑫 戴军[1] 罗艳[2] 孙福康[1] MA Wenming;LI Qiang;ZHUO Ran;MAO Yongxin;DAI Jun;LUO Yan;SUN Fukang(Department of Urology,Ruijin Hospital Shanghai Jiao Tong University School of Medicine;Anesthesiology,Ruijin Hospital Shanghai Jiao Tong University School of Medicine)

机构地区：[1]上海交通大学医学院附属瑞金医院泌尿外科,上海200025 [2]上海交通大学医学院附属瑞金医院麻醉科,上海200025

出　　处：《诊断学理论与实践》2020年第2期172-176,共5页Journal of Diagnostics Concepts & Practice

基　　金：国家自然科学基金(81972494);上海市卫生计生委智慧医疗专项研究项目(2018ZHYL0205)。

摘　　要：目的:分析嗜铬细胞瘤患者术前的CT影像学资料,评价其在嗜铬细胞瘤患者术前、术中及术后评估中的应用价值。方法:收集我院164例嗜铬细胞瘤患者术前的CT检查参数,并收集其术前血儿茶酚胺激素[包括甲氧基肾上腺素(metanephrine,MN)和甲氧基去甲肾上腺素(normetanephrine,NMN)]水平、术中失血量、麻醉用药情况及术后并发症等相关资料,分析肿瘤的CT影像学参数与MN、NMN水平间的关系,计算肿瘤部位的增强CT值与嗜铬细胞瘤体积的乘积(enhanced CT value×volume,EV)值及其与术中失血量、麻醉用药情况、术后并发症发生情况间的相关性。结果:①嗜铬细胞瘤患者的术前血NMN(P<0.001,r=0.535)、MN(P=0.001,r=0.257)水平与EV值间有一定相关性。多变量线性回归分析显示,术前血NMN(P=0.001)水平是EV值升高的独立影响因素。②患者术中麻醉使用的酚妥拉明用量(P=0.001,r=0.279)、术中失血量(P<0.001,r=0.479)与EV值呈显著正相关。当患者的EV值大于4719.65 HU·cm^3(曲线下面积为0.890)时,其术中失血量>800 mL的风险明显升高(OR=1.349)。③患者的术后并发症发生情况与其EV值间呈显著正相关(P<0.001,r=0.317),当EV大于15610.62 HU·cm^3(曲线下面积为0.799)时,患者术后发生大于Ⅱ级并发症的风险明显升高(OR=1.640)。结论:嗜铬细胞瘤患者术前CT影像学参数(EV值)与其术前血儿茶酚胺激素水平、术中失血量及麻醉使用的酚妥拉明总量、术后并发症发生情况显著相关,可为患者进行充分术前准备、术中麻醉风险估计、术后并发症预估提供重要的参考依据。Objective:To explore the value of pre-operative CT scanning for preoperative,intraoperative,and postoperative evaluation of patients with pheochromocytoma.Methods:A total of 164 patients with pheochromocytoma were enrolled from January 2014 through April 2019.Correlation of pre-operative CT imaging parameters product of enhanced CT value in the lesion and tumor size(EV)with levels of preoperative metanephrine(MN)and normetanephrine(NMN),loss of intraoperative blood,postoperative complications were analyzed.Results:Both pre-operative NMN and MN were positively correlated with EV(P<0.001,P=0.001).Multivariate analysis showed that NMN was an independent factor for increment of EV(P=0.001).EV had a significant positive correlation with intraoperative dosage of phentolamine(P<0.001)and blood loss(P<0.001).Receiver operator characteristic(ROC)curve analysis showed that when EV was greater than 4719.65 HU·cm^3(P<0.001,AUC=0.890),the risk of major intraoperative blood,defined as loss>800 mL,increased significantly.EV was positively correlated with incidence of postoperative complications(P<0.001).When EV was greater than15610.62 HU·cm^3(P<0.001,AUC=0.799),the risk of postoperative complications>Ⅱsignificantly increased.Conclusions:CT-based imaging parameter EV is highly correlated with intraoperative phentolamine dosage,incidence of postoperative complications and levels of pre-operative NM,NMN.Pre-operative CT scanning might provide important information for preoperative preparation,intraoperative anesthesia and prevention of postoperative complications in the man-angement of pheochromocytoma.

关 键 词：嗜铬细胞瘤 计算机体层成像 评估 并发症 

分 类 号：R586.9[医药卫生—内分泌]