经肝动脉化疗栓塞治疗5例恶性嗜铬细胞瘤术后复发动脉

Transarterial Chemoembolization of Recurrent Malignant Pheochromocytoma After Surgical Excision: Report of 5 Cases

目的:评价经动脉化疗栓塞术(TACE)治疗恶性嗜铬细胞瘤术后复发的安全性和疗效性。方法:总结经TACE术5例恶性嗜铬细胞瘤的资料。4例血压升高者术前用α-肾上腺素能阻滞剂和β-受体阻滞剂调节血压和心率,按Seldinger技术经右侧股动脉插管至肾上腺或/和肝动脉内行TACE术。在行TACE术时均建立静脉通道滴注酚妥拉明,在术后2周内密切观察血压和心率等变化。结果:4例血压升高者通过术前准备后血压和心率均控制在正常范围内。在行TACE术时有4例血压升高,经过术中注入酚妥拉明后血压稳定,1例血压无明显波动。3例TACE术后2周内有低血压表现,通过扩容治疗后血压稳定,2例血压无明显变化。随访2月-2年3月,2例死亡,均非手术所致,3例在TACE术后7月-2年3月仍存活,血压稳定,未出现明显阵发性头晕,面色苍白等症状,实验室检查时香草扁桃酸基本正常。1月后原发肿瘤和转移肿瘤有不同程度缩小。结论:恶性嗜铬细胞瘤术后复发或转移而又不适再次手术者通过术前降压及术中和术后监测,TACE术治疗是安全、可行的,并有一定的疗效。

Objective： To evaluate the safety and therapeutic effects of transarterial chemoembolization （TACE） in recurrent malignant pheochromocytoma after surgical excision. Methods： The clinical data of five cases of malignant pheochromocytoma underwent TACE were reviewed, and of all the cases, 4 cases with hypertension were given α-adrenergic blockers and β-adrenergic blockers for control of heart rate and blood pressure before TACE, and all five cases were given α-adrenergic blockers during TACE. More attention were paid into monitoring the blood pressure and heart rate in the following two weeks after TACE. Results： The blood pressure and heart rate of four cases with hypertension were controlled before TACE. Paroxysmal hypertension occurred in four cases and were controlled by administration of α-adrenergic blockers and β-adrenergic blockers, and only one case remained stable blood pressure during TACE. Hypotension appeared in three cases and controlled by maintainint the blood volume. All the five cases were followed up ranged from two months to two years and three months. Two cases died of recurrence and epilepsy, and the other three cases were still surviving for 7 to 27 months with smaller tumor size and without clinical chromo manifestations of severe hypertens cytoma after surgical excision is sa ion. Conclusion： TACE for fe and effective if the blood recurrent pressure malignant pheois controlled and been monitoring well.