妊娠合并嗜铬细胞瘤的诊断与处理

目的 探讨妊娠合并嗜铬细胞瘤的诊断与处理方法.方法 妊娠合并嗜铬细胞瘤病例3例.年龄分别为41、28、32岁,均为妊娠期间出现高血压,并伴有头痛、心悸、多汗等症状,分别于妊娠27周+1,12周+4,14周+3就诊.24 h尿儿茶酚胺明显升高;肿瘤位于右肾上腺2例,双侧肾上腺1例,肿瘤直径4.5～10.0 cm,术前诊断"妊娠合并嗜铬细胞瘤".结果 例1于孕32周行全麻下剖宫产术,顺利分娩一健康女婴,同时行后腹腔镜下右肾上腺肿瘤切除术,切除7.0 cm肿瘤1枚.例2及例3均选择流产.例2行后腹腔镜下右肾上腺肿瘤切除术,切除右肾上腺4.5 cm肿瘤1枚.例3拒绝进一步治疗.例1及例2术后病理均证实为嗜铬细胞瘤.结论 对于妊娠早期出现高血压、典型发作性高血压或伴有头痛、心悸、大汗三联征,分娩后高血压仍未恢复正常的孕妇,应考虑嗜铬细胞瘤;及时诊断可显著降低母亲及胎儿死亡率;处理上应根据妊娠所处的时期及嗜铬细胞瘤的功能状态选择恰当的方式.妊娠中期是较理想的手术治疗时机.腹腔镜手术治疗妊娠嗜铬细胞瘤安全、有效.

Abstract：

Objective To discuss the diagnosis and management of pheochromocytoma in pregnancy. Methods Three cases of pheochromocytoma in pregnancy were managed from 2007- 2009.Case 1, a 41-year-old woman presented with paroxysmal hypertension during 27+1 weeks' gestation.The accompanied symptoms included dizziness, palpitation and sweating. Both B ultrasound and MRI revealed a right adrenal tumor about 7 cm in diameter. The 24-hour catecholamine was higher than normal. A diagnosis of right adrenal pheochromocytoma was made. Case 2, a 28-year-old woman presented with hypertension during 12+4 weeks' gestation. B ultrasound showed a right adrenal tumor about 5 cm in diameter. The 24-hour catecholamine was higher than normal. Case 3, a 32-year-old woman presented with hypertension during 14+3 weeks' gestation. B ultrasound revealed bilateral adrenal tumors. The 24-hour catecholamine was higher than normal. The diagnosis of bilateral adrenal pheochromocytomas was made. Results The first patient delivered a healthy female infant through cesarean section at 32 weeks' gestation. Laparoscopic resection of right adrenal pheochromocytoma was successfully performed at the same time. Both the second and third patients had elective abortion for fear of fetotoxicity. Case 2 accepted laparoscopic resection of right adrenal pheochromocytoma after 4 weeks' medical preparation. Case 3 rejected surgery. The histopathological findings proved pheochromocytoma in case 1 and case 2. Conclusions Pheochromocytoma should be included in the defferential diagnosis in hypertension occurring during pregnancy especially in the following situations:hypertension during early pregnancy; paroxymal hypertension accompanied by headache, palpitation and sweating; hypertension does not relieve after delivery. Early diagnosis and management with medical treatment followed by surgical removal usually results in good maternal and fetal outcomes. The second trimester is good timing of surgical management. Laparoscopic removal of pheochromocytoma is safe in pregnancy.

Diagnosis and management of pheochromocytoma in pregnancy

Objective To discuss the diagnosis and management of pheochromocytoma in pregnancy. Methods Three cases of pheochromocytoma in pregnancy were managed from 2007- 2009.Case 1, a 41-year-old woman presented with paroxysmal hypertension during 27+1 weeks' gestation.The accompanied symptoms included dizziness, palpitation and sweating. Both B ultrasound and MRI revealed a right adrenal tumor about 7 cm in diameter. The 24-hour catecholamine was higher than normal. A diagnosis of right adrenal pheochromocytoma was made. Case 2, a 28-year-old woman presented with hypertension during 12+4 weeks' gestation. B ultrasound showed a right adrenal tumor about 5 cm in diameter. The 24-hour catecholamine was higher than normal. Case 3, a 32-year-old woman presented with hypertension during 14+3 weeks' gestation. B ultrasound revealed bilateral adrenal tumors. The 24-hour catecholamine was higher than normal. The diagnosis of bilateral adrenal pheochromocytomas was made. Results The first patient delivered a healthy female infant through cesarean section at 32 weeks' gestation. Laparoscopic resection of right adrenal pheochromocytoma was successfully performed at the same time. Both the second and third patients had elective abortion for fear of fetotoxicity. Case 2 accepted laparoscopic resection of right adrenal pheochromocytoma after 4 weeks' medical preparation. Case 3 rejected surgery. The histopathological findings proved pheochromocytoma in case 1 and case 2. Conclusions Pheochromocytoma should be included in the defferential diagnosis in hypertension occurring during pregnancy especially in the following situations:hypertension during early pregnancy; paroxymal hypertension accompanied by headache, palpitation and sweating; hypertension does not relieve after delivery. Early diagnosis and management with medical treatment followed by surgical removal usually results in good maternal and fetal outcomes. The second trimester is good timing of surgical management. Laparoscopic removal of pheochromocytoma is safe in pregnancy.