中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2009年
2期
77-80
,共4页
毕建斌%宫大鑫%孔垂泽%李泽良%杨绍波%王毅%李振华%杨春明%刘贤奎%都书琪%赵伟%孙长成%姜元军%刘涛
畢建斌%宮大鑫%孔垂澤%李澤良%楊紹波%王毅%李振華%楊春明%劉賢奎%都書琪%趙偉%孫長成%薑元軍%劉濤
필건빈%궁대흠%공수택%리택량%양소파%왕의%리진화%양춘명%류현규%도서기%조위%손장성%강원군%류도
肾上腺肿瘤%嗜铬细胞瘤%血压正常%围手术期医护
腎上腺腫瘤%嗜鉻細胞瘤%血壓正常%圍手術期醫護
신상선종류%기락세포류%혈압정상%위수술기의호
Adrenal gland neoplasmas%Pheochromocytoma%Normal blood pressure%Perioperative care
目的 提高血压正常的肾上腺嗜铬细胞瘤的诊治水平. 方法 回顾性分析22例正常血压的肾上腺嗜铬细胞瘤患者资料.男9例,女13例.平均年龄42岁.既往均无高血压病史和高血压临床表现,入院时血压90～130/60～90 mm Hg(1 mm Hg=0.133 kPa),平均113/72 mmHg.其中无症状体检B超发现肾上腺肿瘤7例,腰腹部疼痛不适12例,乏力4例,发热2例,头晕、心悸1例.B超及CT检查见肾上腺轮廓较清晰的囊实性肿物,中央有液化坏死区,周边实性部分可见不均匀强化.肾上腺素及去甲肾上腺素升高19%(14/21)、尿儿茶酚胺升高28%(5/18)、香草基扁桃酸升高22%(4/18).术前拟诊为无功能肾上腺皮质腺瘤3例、腹膜后肿瘤1例、肾上腺嗜铬细胞瘤18例.术前予扩容治疗7例,其中同时给予哌唑嗪治疗2例. 结果 22例均行手术治疗.术中出现血压波动17例,给予盐酸乌拉地尔、酚妥拉明等控制血压,输血补液、去甲肾上腺素处理低血压.7例经术前扩容治疗患者术中出现血压明显波动1例,15例术前未经扩容患者术中出现血压明显波动11例.21例手术成功切除肿瘤,探查仅取活检1例.22例均经病理证实为嗜铬细胞瘤.21例随访1个月～7年,手术切除肿瘤患者均无复发,血压正常平稳. 结论 血压正常的嗜铬细胞瘤患者儿茶酚胺及其代谢产物水平较低,定性诊断困难,典型的影像学表现对诊断有较大帮助;血压正常的嗜铬细胞瘤患者术前也应常规应用α受体阻滞剂和扩容治疗,可以降低手术风险、减少并发症.
目的 提高血壓正常的腎上腺嗜鉻細胞瘤的診治水平. 方法 迴顧性分析22例正常血壓的腎上腺嗜鉻細胞瘤患者資料.男9例,女13例.平均年齡42歲.既往均無高血壓病史和高血壓臨床錶現,入院時血壓90～130/60～90 mm Hg(1 mm Hg=0.133 kPa),平均113/72 mmHg.其中無癥狀體檢B超髮現腎上腺腫瘤7例,腰腹部疼痛不適12例,乏力4例,髮熱2例,頭暈、心悸1例.B超及CT檢查見腎上腺輪廓較清晰的囊實性腫物,中央有液化壞死區,週邊實性部分可見不均勻彊化.腎上腺素及去甲腎上腺素升高19%(14/21)、尿兒茶酚胺升高28%(5/18)、香草基扁桃痠升高22%(4/18).術前擬診為無功能腎上腺皮質腺瘤3例、腹膜後腫瘤1例、腎上腺嗜鉻細胞瘤18例.術前予擴容治療7例,其中同時給予哌唑嗪治療2例. 結果 22例均行手術治療.術中齣現血壓波動17例,給予鹽痠烏拉地爾、酚妥拉明等控製血壓,輸血補液、去甲腎上腺素處理低血壓.7例經術前擴容治療患者術中齣現血壓明顯波動1例,15例術前未經擴容患者術中齣現血壓明顯波動11例.21例手術成功切除腫瘤,探查僅取活檢1例.22例均經病理證實為嗜鉻細胞瘤.21例隨訪1箇月～7年,手術切除腫瘤患者均無複髮,血壓正常平穩. 結論 血壓正常的嗜鉻細胞瘤患者兒茶酚胺及其代謝產物水平較低,定性診斷睏難,典型的影像學錶現對診斷有較大幫助;血壓正常的嗜鉻細胞瘤患者術前也應常規應用α受體阻滯劑和擴容治療,可以降低手術風險、減少併髮癥.
목적 제고혈압정상적신상선기락세포류적진치수평. 방법 회고성분석22례정상혈압적신상선기락세포류환자자료.남9례,녀13례.평균년령42세.기왕균무고혈압병사화고혈압림상표현,입원시혈압90～130/60～90 mm Hg(1 mm Hg=0.133 kPa),평균113/72 mmHg.기중무증상체검B초발현신상선종류7례,요복부동통불괄12례,핍력4례,발열2례,두훈、심계1례.B초급CT검사견신상선륜곽교청석적낭실성종물,중앙유액화배사구,주변실성부분가견불균균강화.신상선소급거갑신상선소승고19%(14/21)、뇨인다분알승고28%(5/18)、향초기편도산승고22%(4/18).술전의진위무공능신상선피질선류3례、복막후종류1례、신상선기락세포류18례.술전여확용치료7례,기중동시급여고서진치료2례. 결과 22례균행수술치료.술중출현혈압파동17례,급여염산오랍지이、분타랍명등공제혈압,수혈보액、거갑신상선소처리저혈압.7례경술전확용치료환자술중출현혈압명현파동1례,15례술전미경확용환자술중출현혈압명현파동11례.21례수술성공절제종류,탐사부취활검1례.22례균경병리증실위기락세포류.21례수방1개월～7년,수술절제종류환자균무복발,혈압정상평은. 결론 혈압정상적기락세포류환자인다분알급기대사산물수평교저,정성진단곤난,전형적영상학표현대진단유교대방조;혈압정상적기락세포류환자술전야응상규응용α수체조체제화확용치료,가이강저수술풍험、감소병발증.
Objective To discuss the diagnosis and treatment of normotensive pheochromocyto-ma. Methods The clinical data of 22 patients with normotensive pheochromocytoma were reviewed. Inclusion criteria for normotensive pheochromocytoma were no previous history of hypertension and episode of symptoms suggesting high blood pressure. The blood pressure on admission was 90-130/ 60-90 mm Hg with an average of 113/72 mm Hg. Seven patients were found adrenal mass by routine ultrasonic examination. Twelve patients presented with superior abdominal or flank pain. Four pa-tients were present with fatigue, and 2 patients had fever. Headache and palpitation were found in 1 patient. Most of patients were present with large and round mass with low density area in the center of the tumor by uhrosonography and CT. Four patients had elevated level of plasma epinephrine and nor-epinephrine. 24 hours urine CA and VMA were elevated in 5 and 4 patients respectively. Seven pa-tients were prepared with infusion preoperatively to expand intravascular volume, and 2 patients were given prazosin 1.5 mg/d for 5 to 7 days. Results During the operation, seventeen patients had ele-vated blood pressure and 5 patients had no changed. One of seven patients with preoperative prepara-tion had obvious hypertension during operation, and 11 of 15 patients without preoperative preparation had obvious hypertension. The tumors were removed successfully in 21 patients. All the patients were diagnosed pheochromocytoma pathologically. Twenty-one patients had normal blood pressure with no recurrence during the follow-up from 1 month to 7 years. Conclusions The patients with normotensive pheochromocytomas may have lower catecholamine in their plasma and urine. The application of α-blockers and the expanding intravascular volume before operation could be important for the patients safe.
