CAJ | 학술논문

目的提高嗜铬细胞瘤/副神经节瘤的治疗水平.方法回顾性总结2003年至2011年10月间经手术治疗的167例嗜铬细胞瘤和25例副神经节瘤患者的临床资料.患者资料显示高血压141例,血浆游离肾上腺素类物质(MNs)和24h尿儿茶酚胺(CA)升高率分别为92.8％(142/153)和90.1％(137/152),B超、CT、MRI和131I-间碘苄胍扫描(131I-MIBG)定位准确率分别为83.9％(125/149)、95.5％(106/111)、98.1％ (53/54)和73.1％ (71/97).结果所有患者均接受手术治疗,167例嗜铬细胞瘤行腹腔镜手术18例,开放手术149例,其中经腰部切口108例,胸腹联合切口4例,上腹部L型切口30例,腹部倒八字切口7例；25例副神经节瘤均行开放手术治疗,其中上腹部正中切口8例,下腹部正中切口5例,上腹部L型切口12例,病理检查确诊恶性23例.术后随访7个月～8年,复发11例,其中9例行2次或多次手术,死亡5例.结论嗜铬细胞瘤需根据肿瘤的大小、部位及其与周围组织、脏器的关系选择合适的手术方式和手术径路；超声、CT、MRI和1311-MIBG是重要的定位诊断方法；术前准备充分、术中出血合理处理是手术成功的关键.
목적 제고기락세포류/부신경절류적치료수평.방법 회고성총결2003년지2011년10월간경수술치료적167례기락세포류화25례부신경절류환자적림상자료.환자자료현시고혈압141례,혈장유리신상선소류물질(MNs)화24h뇨인다분알(CA)승고솔분별위92.8％(142/153)화90.1％(137/152),B초、CT、MRI화131I-간전변고소묘(131I-MIBG)정위준학솔분별위83.9％(125/149)、95.5％(106/111)、98.1％ (53/54)화73.1％ (71/97).결과 소유환자균접수수술치료,167례기락세포류행복강경수술18례,개방수술149례,기중경요부절구108례,흉복연합절구4례,상복부L형절구30례,복부도팔자절구7례；25례부신경절류균행개방수술치료,기중상복부정중절구8례,하복부정중절구5례,상복부L형절구12례,병리검사학진악성23례.술후수방7개월～8년,복발11례,기중9례행2차혹다차수술,사망5례.결론 기락세포류수근거종류적대소、부위급기여주위조직、장기적관계선택합괄적수술방식화수술경로；초성、CT、MRI화1311-MIBG시중요적정위진단방법；술전준비충분、술중출혈합리처리시수술성공적관건.
Objectives To evaluate the surgical treatment of pheochromocytoma/ paraganglion.Methods 167 cases of adrenal pheochromocytoma and 25 cases of paraganglion surgical treated between from January 2003 to October 2011 were retrospective analyzed.Hypertension was observed in 141 cases.The positive rate of plasmafree MNs and 24-hour urine CA was 92.8％ (142/153) and 90.1％ (137/152) respectively.The accuracy rate of location of B-Ultrasound,CT,MRI and 1311-MIBG was 83.9％ (125/149) 、95.5 ％ (106/111) 、98.1％ (53/54) 和 73.1％ (71/97).Results All of patients received operations.18 patients were treated with laparoscope.For 149 cases of patients,108 cases were chosen by lumbodorsal incision,4 by abdominothoracic incision,30 by superior abdominal L-shape incision,and 7 by inverse splayed incision.25 cases of paraganglion were treated with open surgery.8 cases were chosen by superior median abdominal incision,5 by inferior median abdominal incision,and 12 by superior abdominal L-shape incision.All specimens were proved to be paraganglion.All patients have been followed up for 7 months to 8 years,during which 11 cases had tumor recurrence and 9 underwent re-operation.5 cases died postoperatively.Conclusions Surgical treatment of pheochromocytoma/paraganglion depends on tumor's size,location and relation with the surrounding tissues.Ultrasonography,CT,MRI and 1311-MIBG can be used to formulate the surgical proposed and approach.The sufficient preparations and proper homeostasis during the operation are the keys of the success of the surgery.