嗜铬细胞瘤合并肾动脉狭窄

目的提高对嗜铬细胞瘤合并肾动脉狭窄（ＲＡＳ）的诊断与治疗水平。方法报告４例嗜铬细胞瘤合并ＲＡＳ。４例患者均行嗜铬细胞瘤切除术。结果２例切除ＲＡＳ肾及１例松解局部粘连所致ＲＡＳ患者血压均正常,而１例松解长段ＲＡＳ后保留ＲＡＳ肾者持续高血压。结论当嗜铬细胞瘤定性与定位之后在上腹部或背部闻及血管杂音,一侧肾影变小或遇到单用α受体阻滞剂降血压效果欠佳,需加用血管紧张素转化酶抑制剂者,以及嗜铬细胞瘤术后血压持续不降而又排除残留嗜铬细胞瘤者均应考虑合并ＲＡＳ可能。对因嗜铬细胞瘤直接压迫,粘连造成肾动脉成角或局部狭窄者,在去除嗜铬细胞瘤及松解粘连之后ＲＡＳ多能缓解,而对嗜铬细胞瘤致肾动脉广泛狭窄或闭塞,肾实质明显萎缩者,应切除患肾。

Coexisting pheochromocytoma and renal artery stenosis

OBJECTIVE: To improve the diagnosis of coexisting pheochromocytoma and renal artery stenosis. METHOD: Four patients with coexisting pheochromocytoma and renal artery stenosis were treated. RESULT: After removal of the pheochromocytoma, the blood pressure became normal in two patients combined with resection of kidney with renal artery stenosis, and one patient with local adhesion loosened. The hypertension, however, persisted in another patient after the resection of pheochromocytoma even though the long segment of renal artery stenosis was relieved. CONCLUSION: After pheochromocytoma was diagnosed with its known position, coexisting renal artery stenosis should be suspected according to one of the following conditions: (1) Vascular murmurs are noted at the area of the upper abdomen or back; (2) One of the kidneys becomes less sized; (3) Using the inhibitor of receptor alpha only has no effect lowering blood pressure and it is necessary to add the inhibitor of angiotension; (4) Postoperative hypertension does not resolve when no remaining pheochromocytoma is present. the renal artery stenosis can be reversed after both removal of pheochromocytoma and loosening of adhesion in case of stenosis due to the pressure of the tumor and adhesion caused renal artery angling and local stricture. Extensive stenosis or closure, however, can not be corrected with severe atrophy of renal parenchyma due to pheochromocytoma, and the resection of kidney should be indicated.