Diagnosis and treatment of pheochromocytoma. Report of 48 cases]

A total of 48 patients with pheochromocytoma were treated during 1965-1989. The incidence of pheochromocytoma was about 2% in hypertensive patients at same period. In this series, 31 (64.6%) had adrenal pheochromocytoma and 17 (35.4%) extra-adrenal pheochromocytoma. More than 50% of the patients showed such symptoms as hypertension, headache, sweating and palpitation. Urinary catecholamine level was significantly elevated in 97.6% of the patients. In tumor localization, CT showed an accurate diagnostic rate of 95.5% and ultrasonography 85.7%. The fluctuation of blood pressure and the amount of fluid requirement during operation in phenoxybenzamine-treated patients were lower than those in non-phenoxybenzamine-treated patients, but there was no statistically significant difference between < 14 days of treatment group and > 14 days of treatment group in phenoxybenzamine-treated patients. 47 patients underwent complete excision of tumor, except 1 patient with a gigantic tumor from the organs of Zuckerkandl. One patient died after operation.     

成人美克耳憩室49例诊治分析

目的探讨成人美克耳憩室的临床表现、诊断及治疗方法,以提高成人美克耳憩室的诊治水平。方法对我院1995年4月~2005年4月收治的成人美克耳憩室49例的临床资料进行回顾性分析。本组病人均经手术治疗。其中,行憩室切除加小肠部分切除32例,憩室切除加小肠楔形切除11例,腹腔镜辅助憩室切除加小肠部分切除6例。结果本组病例病理检查结果显示,美克耳憩室内有异位胃组织者21例,有异位胰腺组织者2例。本组病例均治愈出院。随访6月~10年,疗效满意。结论成人美克耳憩室主要表现为下消化道出血、急性憩室炎或小肠梗阻,无论有无临床症状,一经确诊,均以手术治疗为宜。腹腔镜可作为诊断和治疗成人美克耳憩室引起消化道出血的常规方法。     

膀胱嗜铬细胞瘤的诊断和治疗

目的：提高膀胱嗜铬细胞瘤的诊断与治疗水平。方法：5例膀胱嗜铬细胞瘤患者均通过膀胱镜检查获得定位诊断并均经手术治疗，其中4例行膀胱部分切除，1例行全膀胱切除术。结果：5例获随访，时间2个月～9年。3例痊愈，2例分别于术后2个月、5年死于脑溢血。结论：膀胱镜是最主要的定位检查手段，术前准备与其他部位嗜铬细胞瘤同样重要，术式选择应依据病灶大小及部位。     

膀胱嗜铬细胞瘤7例诊治分析

目的探讨膀胱嗜铬细胞瘤的诊断和治疗经验。方法回顾性分析本院2003年4月至2010年4月诊治的7例膀胱嗜铬细胞瘤患者的临床资料。男性3例,女性4例,平均年龄45.3（31~57）岁。高血压者6例,5例在排尿时血压明显增高;间歇性肉眼血尿者3例。血浆游离MNs和24h尿CA定性诊断的阳性率分别为100.0%（7/7）和85.7%（6/7）。定位检查包括B超、CT、MRI、131I-MIBG和膀胱镜,其各自的定位准确率分别为85.7%（6/7）、100.0%（6/6）、66.7%（2/3）、100.0%（5/5）和75.0%（3/4）。1例进行放射治疗,2例实施膀胱部分切除,4例进行肿瘤剜除。结果 7例膀胱嗜铬细胞瘤在膀胱内的位置为：前壁2例、三角区2例、后壁1例、左侧壁1例、右侧壁1例。平均手术时间131.2（110~190）min,平均出血量283（100~1 200）mL。良性者6例,恶性者1例。随访5个月~7年,1例于术后3年复发,2次手术行全膀胱切除术。结论膀胱嗜铬细胞瘤罕见且容易误诊,高血压、血尿、排尿时典型发作为其主要症状;血浆游离MNs和24h尿CA是重要的定性检查方法,B超、CT、MRI、131I-MIBG及膀胱镜是重要的定位诊断方法;膀胱部分切除或肿瘤剜除是首选的治疗方法,术后应长期随访。     

Extra-adrenal pheochromocytoma. Report of two cases

Paraganglioma is rare neoplasm. The authors report two new cases. The first case was a 36 year-old woman who presented with post-micturitional episodes of hypertension. Radiologic and endoscopic investigations showed a left submucosal bladder neck tumor. A partial cystectomy was performed under neuroleptanalgesia. The postoperative course was uneventful is simple. The second case was a 61 year-old woman who presented with a non secreting para-aortic paraganglioma.     

原发性腹膜后肿瘤49例诊断和治疗体会

目的探讨原发性腹膜后肿瘤的诊断和治疗方法。方法回顾性分析我院1990年~2005年经过外科手术治疗的49例腹膜后肿瘤的临床资料。结果良性肿瘤28例,恶性肿瘤21例。肿瘤完整切除41例,合并脏器切除9例,肿瘤大部切除6例。本组无手术死亡病例,均治愈出院。术后并发肠梗阻、胃无力、应激性溃疡各1例。结论充分的术前准备、多专科的参与及良好的手术技能是保障手术顺利完成的关键。     

Adrenal gland pheochromocytoma. Report of 26 cases

The authors analyse of a series of 26 patients (17 females and 9 males) with a mean age of 32 years (range: 18 to 55 years) operated for adrenal phaeochromocytoma. All patients were hypertensive. The laboratory assessment (assay of blood catecholamines and urinary catecholamine metabolites) performed in more than 2/3 of cases confirmed the diagnosis in more than 80% of cases. The topographic diagnosis was facilitated by computed tomography. Fifteen patients received preoperative treatment with alpha-blockers or calcium channel blockers. Various incisions were used, but a lumbar incision was the most frequent. Blood pressure was controlled postoperatively in 24 patients. Two patients died 1 and 2 postoperatively. New diagnostic modalities (CT, MRI) have facilitated the diagnosis and the site of localization of phaeochromocytomas, thereby improving the choice of incision. Patient-specific preoperative preparation and appropriate anaesthesia facilitate successful adrenal gland surgery.     

妊娠期嗜铬细胞瘤的诊断和治疗(附2例报告)

目的：总结对妊娠期嗜铬细胞瘤的诊治经验。方法：结合文献回顾性２例本病患者的临床资料。结果：术前１～２周均口服苯苄胺控制血压。对１例中期妊娠者在全麻下行肿瘤摘除术，对１例晚期妊娠者，行剖宫产后行肿瘤切除术。术后母、婴均健康；结论：本病对孕妇及胎儿危害性极大，产前确诊并及时治疗可降低母、婴病死率。     

29例恶性嗜铬细胞瘤诊治分析

目的总结恶性嗜铬细胞瘤的诊治经验。方法回顾性分析2003年4月至2011年1月诊治的29例恶性嗜铬细胞瘤患者的临床资料。高血压26例（89．7％）,血浆游离肾上腺素类物质（MNs）和24h尿儿茶酚胺（CA）升高者分别为92．3％（24／26）和86．2％（25／29）。B超、CT、MRI和^131I-间碘苄胍扫描（^131I-MIBG）定位准确率分别为86．2％（25／29）、96．6％（28／29）、88．9％（8／9）和81.2％（18／22）,拟诊恶性者分别为24．1％（7／29）、55．2％（16／29）、44．4％（4／9）和40．9％（9／22）。1例行放射治疗,27例行开放手术,1例行后腹腔镜手术。结果29例患者位于肾上腺17例（58．6％）,肾上腺外12例（41．4％）。首次手术根据肿瘤结构破坏、浸润生长及淋巴结转移确诊恶性13例（44．8％）。病理检查28例,确诊恶性23例（82．1％）。术后随访24例,时间4个月～8年,肿瘤复发11例,其中9例行2次或多次手术。肺转移4例,肝转移4例,骨转移3例,局部淋巴结转移4例,广泛淋巴结转移2例,2个或多个脏器同时发生转移3例。死亡4例：其余存活至今。结论病理难以区分嗜铬细胞瘤的良恶性,需结合影像学检查、生化检查及术中所见。根治性肿瘤切除是治疗恶性嗜铬细胞瘤最有效的方法,肿瘤复发时再次手术仍然有效。长期随访观察肿瘤的转移情况对最终确诊疑似病例和及时治疗尤为重要。     

嗜铬细胞瘤的诊治(附85例报告)

目的　探讨嗜铬细胞瘤的诊断治疗。　方法　报告１９６７ ～１９９７ 年收治的８５ 例嗜铬细胞瘤。临床表现为高血压者７８ 例（９２ ％ ） ，７３ 例尿ＶＭＡ 检查，其中６８ 例高于正常，阳性率９３ ％ 。Ｂ超、ＣＴ 和ＭＲＩ定位诊断的阳性率分别为９０ ％ 、９６ ％ 和１００％ 。　结果　全部病例均经手术和病理证实，其中良性７７ 例（９１％ ） ，恶性８ 例（９ ％ ） ；肿瘤位于肾上腺７１ 例（８４％ ） ，异位嗜铬细胞瘤１４ 例（１６ ％ ） 。　结论　强调充分的术前准备，手术切除肿瘤是根本的治疗方法     

嗜铬细胞瘤临床诊治

目的 提高嗜铬细胞瘤的诊治水平。方法 总结１９５８年至１９９８年间经手术和病理证实的嗜铬细胞瘤２８６例。结果 本组２２０例患者肿瘤位于肾上腺,６６例位于肾上腺外。在２９例恶性嗜铬细胞瘤中,７例位于肾上腺,２２例位于肾上腺外。１９例为静止型嗜铬细胞瘤。手术切除肿瘤２８１例。结论 对潜在的儿茶酚胺性心肌病的防治可降低手术死亡率。恶性嗜铬细胞瘤的诊断要靠长期严密的随访。     

嗜铬细胞瘤的诊断和治疗

嗜铬细胞瘤(PHEOs)是通过分泌儿茶酚胺引起临床症状的神经内分泌肿瘤.生化指标检测可对肿瘤定性,解剖及功能性影像学检查可对肿瘤进行定位,本文将对PHEOs的诊断和治疗现状进行讨论.     

Diagnosis and treatment of pheochromocytoma

Early detection of a pheochromocytoma is necessary to avoid the cardiovascular complications of hypertension and to recognize the 10% of malignant neoplasms. Hypertensive changes, particularly hypertensive spikes and stable hypertension are the most common clinical features. A pheochromocytoma must be suspected in presence of various symptoms of which cephalea, tachycardia, diaphoresis are the most frequently encountered. Plasma catecholamines and 24-hours urine metabolites measurements have 60-100% and 72-99% sensitivity respectively. Radiologic procedures commonly used to locate a pheochromocytoma include CT and RM: they achieve 100% sensitivity for unilateral adrenal lesions and respectively 64% and 88% sensitivity for extra-adrenal lesions. Scintigraphic localization with MIBG provides functional informations and is recommended for follow-up of the recurrent or metastatic pheochromocytoma. Preoperative medical treatment using alpha and beta blocking agents or calcium channel blockers has contributed to reduce perioperative morbidity and mortality. Anterior transabdominal approach is advocated as the standard operative procedure; this approach allows ready access to any site where tumors are obviously present and permits thorough exploration of the abdominal cavity for additional contralateral adrenal or extra-adrenal lesions. An accurate preoperative localization of a sporadic, unilateral, of less than 7-10 cm, benign neoplasm constitutes the indication for the laparoscopic adrenalectomy. Pheochromocytoma-free survival were 92% and 80% at 5 and 10 years respectively; in living patients without recurrence, hypertension-free survival was 74% and 45% at 5 and 10 years respectively. Extra-adrenal pheochromocytomas are frequently malignant (36%) and are associated with a high incidence of persistent or recurrent disease (32%).     

肾上腺外嗜铬细胞瘤的诊断和治疗32例报告

目的探讨肾上腺外嗜铬细胞瘤的诊断和治疗。方法对32例肾上腺外嗜铬细胞瘤患者资料进行回顾性分析,肿瘤位于腹膜后主动脉旁26例,位于膀胱6例。有典型儿茶酚胺症临床表现者29例,24h尿尿香草基杏仁酸(VMA)阳性率为70.8%,CT及MRI定位诊断率分别为96%及83.3%。膀胱嗜铬细胞瘤均经膀胱镜获定位诊断。结果 32例均经开放手术切除肿瘤。全组均经病理证实。无手术死亡病例。结论肾上腺外嗜铬细胞瘤主要依据临床表现、生化定性检查及影像学定位检查明确诊断。术中应重视预防及正确处理手术并发症。长期严密的临床随访是诊断恶性嗜铬细胞瘤的重要依据。     

肾上腺外嗜铬细胞瘤的诊断与治疗(附18例报告)

目的 探讨肾上腺外嗜铬细胞瘤的诊断和治疗方法。方法 回顾性分析18例肾上腺外嗜铬细胞瘤的临床资料。男13例，女5例。平均发病年龄30岁。18例均有不同程度的血压升高，头痛头晕(67％)、心悸多汗(44％)、视物不清(33％)及肉眼血尿(28％)为主要临床症状。尿儿茶酚胺(CA)和(或)3-甲氧4—羟苦杏仁酸(VMA)阳性者16例，阳性率89％。经B超、CT、MRI及膀胱镜等检查，肿瘤位于膀胱7例、腹主动脉旁5例、肾门4例、脐尿管1例、盆腔1例。结果 18例中行肿瘤切除术15例，探查术3例。病理诊断良性16例，恶性2例。5例术后3个月～10年复发。结论 尿CA和VMA测定是定性诊断和监测复发的有效方法。围手术期控制血压和扩容是保障手术安全的关键。术后应长期严密随访。     

肾上腺外嗜铬细胞瘤的诊断及治疗（附48例报告）

目的提高肾上腺外嗜铬细胞瘤的诊断和治疗水平。方法分析1986年至2005年资料完整、经病理证实的肾上腺外嗜铬细胞瘤48例。其中高血压43例、血尿6例,体检发现肿瘤3例。48例患者中尿VMA及血、尿儿茶酚胺升高分别为44例（91%）和40例（83%）。所有患者经B超检查,阳性率为92%、经CT扫描阳性率为100%。48例患者均行手术治疗。结果切除肿瘤40例,包膜下剜除肿瘤8例。手术切除瘤体直径2-9cm。随访6个月-19年,43例高血压患者术后血压正常31例、仍有高血压2例。肿瘤复发、转移6例,恶性嗜铬细胞瘤12例,死亡7例。结论尿VMA及血、尿儿茶酚胺是定性诊断异位嗜铬细胞瘤的主要依据,CT诊断定位准确,131碘-间位碘代苄胍（131I-MIBG）定位准确、敏感性高,且可作为治疗措施。术前降压、扩容、纠正心律失常是手术成功的关键,经腹径路手术暴露良好,肿瘤外侵时可作囊内剜除,术后应密切随访。     

肾上腺外嗜铬细胞瘤的诊断和治疗

广义的嗜铬细胞瘤（pheochromocytoma，PHOE）是指发生在副神经节嗜铬细胞的产生儿茶酚胺（catecholamine，CA）的神经内分泌肿瘤，但是一般只有起源于肾上腺髓质的副神经节肿瘤被称为PHOE，而起源于肾上腺外的副神经节肿瘤被称为副神经节瘤或肾上腺外PHOEE。