CAJ | 학술논문

目的探讨经尿道手术切除膀胱副神经节瘤的安全性和可行性. 方法回顾性分析2008年6月至2014年2月采用经尿道手术切除的11例膀胱副神经节瘤病例.男5例,女6例.年龄30～76岁,平均(54±14)岁.均为膀胱单发肿瘤,术前CT或MRI检查提示肿瘤局限于膀胱壁内.肿瘤最大直径0.9～3.0 cm,平均(1.9±0.8)cm.9例表现为排尿后血压升高,2例表现为持续性高血压.采用B超、增强CT或MRI定位.行24 h尿儿茶酚胺、奥曲肽显像、131I-间位碘代苄胍(MIBG)检查定性.术前均进行药物准备.手术方法采用经尿道切除肿瘤,8例经尿道电切,3例位于膀胱侧壁者为避免闭孔神经反射行2μm激光切除.术后每3～6个月随访,行24 h尿儿茶酚胺测定和CT检查. 结果 11例均成功切除肿瘤,无中转开放手术病例.手术时间20～45 min,平均(34±8)min;估计术中出血量10～ 100 ml,平均(27±26)ml.术中9例出现血压明显波动,收缩压最高达220 mmHg(1 mmHg=0.133 kPa),予硝普钠等控制血压.术后血压均恢复正常.无手术并发症发生.术后病理均为膀胱副神经节瘤.11例随访3～58个月,平均26个月,监测24 h尿儿茶酚胺均正常,CT检查未见肿瘤复发或转移. 结论对于局限于膀胱壁内、体积较小(＜3.0 cm)的膀胱副神经节瘤,经尿道手术安全、有效.对于位于膀胱侧壁的肿瘤为避免闭孔神经反射,采用激光切除更有优势.
목적 탐토경뇨도수술절제방광부신경절류적안전성화가행성. 방법 회고성분석2008년6월지2014년2월채용경뇨도수술절제적11례방광부신경절류병례.남5례,녀6례.년령30～76세,평균(54±14)세.균위방광단발종류,술전CT혹MRI검사제시종류국한우방광벽내.종류최대직경0.9～3.0 cm,평균(1.9±0.8)cm.9례표현위배뇨후혈압승고,2례표현위지속성고혈압.채용B초、증강CT혹MRI정위.행24 h뇨인다분알、오곡태현상、131I-간위전대변고(MIBG)검사정성.술전균진행약물준비.수술방법채용경뇨도절제종류,8례경뇨도전절,3례위우방광측벽자위피면폐공신경반사행2μm격광절제.술후매3～6개월수방,행24 h뇨인다분알측정화CT검사. 결과 11례균성공절제종류,무중전개방수술병례.수술시간20～45 min,평균(34±8)min;고계술중출혈량10～ 100 ml,평균(27±26)ml.술중9례출현혈압명현파동,수축압최고체220 mmHg(1 mmHg=0.133 kPa),여초보납등공제혈압.술후혈압균회복정상.무수술병발증발생.술후병리균위방광부신경절류.11례수방3～58개월,평균26개월,감측24 h뇨인다분알균정상,CT검사미견종류복발혹전이. 결론 대우국한우방광벽내、체적교소(＜3.0 cm)적방광부신경절류,경뇨도수술안전、유효.대우위우방광측벽적종류위피면폐공신경반사,채용격광절제경유우세.
Objective To evaluate the safety and feasibility of transurethral resection of paragangliomas in urinary bladder.Methods Clinical data of 11 patients (5 males and 6 females) with paragangliomas in urinary bladder who underwent transurethral resection in Peking Union Medical College Hospital from June 2008 to February 2014 were analyzed retrospectively.The age ranged from 30 to 76 years (mean 54± 14 years).All cases were diagnosed as single primary tumor.The preoperative CT or MRI showed the tumors located in bladder wall.The diameter of tumors ranged from 0.9-3.0 cm (mean 1.9±0.8).Nine cases presented with hypertension after micturition and 2 cases presented with sustained hypertension.The tumors were localized by B ultrasound,enhanced CT or MRI.The diagnosis was confirmed by detection of 24 hours urinary catecholamine,Octreotide scanning or 131I-MIBG scanning.Transurethral resection of tumors was performed after pharmachological preperation.Eight cases underwent conventional transurethral electroresection and 3 cases underwent transurethral resection with 2 μm thulium laser.All cases were followed up every 3 to 6 months and 24 hours urinary catecholamine and CT scan were performed.Results All tumors were successfully resected without open conversion.The operative time was 20 to 45 min (mean 34±8 min).The estimated blood loss ranged from 10 to 100 ml (mean 27±26 ml).Fluctuation of blood pressure during operation occurred in 9 cases.The maximum systolic blood pressure during operation rised to 220 mmHg (1 mmHg =0.133 kPa) and sodium Nitroprusside was administed to control blood pressure.Blood pressure of all cases returned to normal after operation.No perioperative complications occurred.No recurrence was found during follow-up (3-58 months,mean 26 months).Conclusions For small localized paraganglioma (the diameter less than 3 cm) in urinary bladder,transurethral resection could be a safe and feasible choice of treatment.And 2 μm thulium laser resection has an advantage over conventional electroresection for tumors located in lateral bladder wall to avoid obturator nerve reflex.