异位嗜铬细胞瘤17例临床分析

Diagnosis and treatment features of extra-adrenal pheochromocytoma

目的探讨和分析异位嗜铬细胞瘤的临床诊断和治疗特点。方法分析我院异位嗜铬细胞瘤患者17例。结果尿VMA及血尿儿茶酚胺升高定性诊断分别为16例(94．2％)和15例(88．2％),131I- MIBG显像诊断阳性4例,阳性率100％。B超探及14例(82．4％),CT诊断16例(94．2％),8例进行MRI诊断,阳性率100％。肿瘤平均直径4．6 cm。肿瘤位于腹主动脉旁肾门平面以上5例(29．4％)、以下1例(5．9％),下腔静脉旁肾门平面以上8例(47．1％)、以下2例(11．8％),膀胱壁1例(5．9％),其中肿瘤多发3例。手术切除肿瘤16例,术后高血压缓解15例,术后肿瘤复发3例、伴广泛转移1例。结论检测尿VMA及血、尿儿茶酚胺可作为异位嗜铬细胞瘤定性诊断的初筛检查,131I-MIBG显像定性诊断敏感性准确性高。B超可作为定位诊断的初筛,CT定位诊断准确可靠,MRI可很好地显示肿瘤毗邻和浸润范围。

Objective To explore： and analyze the diagnostic and therapeutic features for extra-adrenal pheochxomocytoma. Methods 17 cases of extra-adrenal pheochromocytoma from 1998 to 2004 were analyzed. Resuits The diagnosis ratio of urinary VMA and serum and urinary catecholamine were 94.2 % and 88.2 % ,131 IMIBG scintigraphy were 100%. The diagnosis ratio by B-ultrasound, CT and MRI were 82.4%, 94.2% and 100% . The mean diameter of tumor was 4.6cm. 5 tumors were located by the side of abdominal aorta and above the renal hilum, 1 tomor was below the renal hilum. 8 tumors were located by the side of inferior vena cava and above the renal hilum,2 tomors were below the renal hilum. 1 tumor was at bladder wall. Tumor resection were made for 16 cases, 15 eases blood pressure were normal after operations. Tumor recurrence were 3 cases, 1 was metastasis. Conclusion Detection of urinary VMA and serum and urinary catecholamine can be screening qualitation diagnosis for ex- tra-adrenalpheochromocytoma. 131IMIBG scintigraphy is accurate and reliable. B-ultrasound can be screening localization diagnosis method. CT and MRI are accurate and can display adjacent and infiltration of tumors.