肾上腺嗜铬细胞瘤/副神经节瘤205例临床分析  

Clinical analysis of 205 cases of pheochromocytoma/paraganglioma

作　　者：朱旋 李志勇[1] 郭胜杰 尧凯[1] 李永红[1] 叶云林[1] 王延军[1] 陈东[1] 吴志明[1] 董培[1] 张志凌[1] 刘卓炜[1] 秦自科[1] 韩辉[1] 周芳坚[1] ZHU Xuan;LI Zhiyong;GUO Shengjie;YAO Kai;LI Yonghong;YE Yunlin;WANG Yanjun;CHEN Dong;WU Zhiming;DONG Pei;ZHANG Zhiling;LIU Zhuowei;QIN Zike;HAN Hui;ZHOU Fangjian(Department of Urology,Sun Yat-Sen University Cancer Center,Guangzhou 510060;Department of Urology,Hubei Hospital of Traditional Chinese Medicine,Wuhan 430061,China)

机构地区：[1]中山大学肿瘤防治中心泌尿外科,广东广州510060 [2]湖北省中医院泌尿外科,湖北武汉430061

出　　处：《现代泌尿外科杂志》2021年第5期405-409,421,共6页Journal of Modern Urology

摘　　要：目的总结肾上腺嗜铬细胞瘤/副神经节瘤(PPGL)的临床特点,提高PPGL的诊疗水平。方法回顾性收集中山大学附属肿瘤医院2003年6月至2019年9月诊治的205例PPGL的临床资料。采用单因素及多因素Logistics分析法研究患者的术前高血压及术中血压波动与性别、年龄、肿瘤最大直径、临床症状、肿瘤位置、病理表现等指标的相关性。结果205例PPGL中有症状者117例(57.1%),术前血压正常者112例(54.7%),术中血压升高131例(69.3%)。患者的术前血压与年龄(P=0.004)、是否有临床症状(P=0.001)以及肿瘤细胞增生活跃(P=0.036)有相关性;而术中血压的波动情况只与肿瘤的大小有相关性(P=0.002);术后转移只与双侧肿瘤有相关性(P=0.006)。肾上腺嗜铬细胞瘤、副神经节瘤和肾上腺嗜铬细胞瘤合并副神经节瘤的术后复发转移率分别为10.5%、21.1%和25.0%。结论大部分PPGL患者术前血压正常,术前血压升高与其肿瘤细胞的增殖水平相关。PPGL的大小仍然是判定手术风险和选择手术方式的最重要指标。PPGL的恶性程度与肿瘤部位密切相关,双侧PPGL恶性度最高。Objective To summarize the clinical characteristics of pheochromocytoma/paraganglioma(PPGL)so as to improve the diagnosis and treatment level.Methods The clinical data of 205 PPGL patients diagnosed and treated in the Cancer Center of Sun Yat-sen University during Jun.2003 and Sep.2019 were retrospectively collected.The correlation of preoperative hypertension and intraoperative blood pressure fluctuation with gender,age,tumor maximum diameter,clinical symptoms,tumor location,pathological manifestations and other indicators was analyzed with univariate and multivariate Logistic analyses.Results Of the 205 cases,117(57.1%)had symptoms,112(54.7%)had normal blood pressure before operation,and 131(69.3%)had elevated blood pressure during operation.Preoperative blood pressure was correlated with age,clinical symptoms and tumor cell proliferation(P=0.004,0.001,0.036).Intraoperative blood pressure fluctuation was only related to tumor size(P=0.002).Postoperative metastasis was only related to bilateral tumors(P=0.006).The recurrence and metastasis rates of adrenal pheochromocytoma,paraganglioma and adrenal pheochromocytoma with paraganglioma were 10.5%,21.1%and 25.0%,respectively.Conclusion Most patients with PPGL have normal blood pressure before operation,and the increase of blood pressure is related to the proliferation of tumor cells.The size of PPGL is the most important index to determine the surgical risk and select the surgical method.The malignancy of PPGL is closely related to tumor location,and bilateral PPGL has the highest malignancy.

关 键 词：嗜铬细胞瘤 副神经节瘤 肾上腺 血压 

分 类 号：R736.6[医药卫生—肿瘤]