CAJ | 학술논문

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1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.
목적 제고무증상신상선기락세포류적진단화치료수평.방법 회고성분석33례무증상신상선기락세포류환자적림상자료.결과 33례무증상신상선기락세포류환자균무전형기락세포류적림상표현.초성급CT검사다표현위륜곽교청석적낭실성종물,중앙유저밀도구혹배사구,주변실질부분가견불균균강화.혈장신상선소급거갑신상선소균승고자5례(16%,5/31),뇨중인다분알(CA)승고자6례(24%,6/25),뇨향초편도산(VMA)승고자5례(20%,5/25);26례술전부의기락세포류적환자급여강압급확용치료;32례성공수술절제종류,탐사취병리술1례;소유병례균경술후병리증실위기락세포류.소유병례수방1개월지7년,무종류복발.결론 무증상신상선기락세포류환자CA급기대사산물수평교저,위정성진단대래곤난.영상학검사대무증상신상선기락세포류적진단유교대방조;대우류체교대、무증상적신상선종류,술전야응안기락세포류상규작약물준비,이감소수술위험성.
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 preut 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 prent 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-adrenergic 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 pheochromocytoma histopathologically,and followed up for 1 month to 7 years, no tumor recurrence. Conclusions The patients with asymptomatic 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.