肾上腺隐匿性嗜铬细胞瘤诊断与治疗（附15例）

Diagnosis and treatment of occult pheochromocytoma of adrenal glands （ report of 15 cases）

目的提高肾上腺隐匿性嗜铬细胞瘤诊断意识和治疗水平。方法回顾性分析15例肾上腺隐匿性嗜铬细胞瘤临床资料。既往无高血压病史。术前均行B超、CT及实验室检查，拟诊无功能肾上腺皮质腺瘤4例、肾上腺隐匿性嗜铬细胞瘤11例。结果15例均手术切除肿瘤，其中开放手术9例，后腹腔镜手术6例。术中出现血压波动10例，硝普钠控制高血压，去甲肾上腺素处理低血压；4例拟诊肾上腺皮质腺瘤术中均出现血压波动，余11例血压波动6例，其中服用酚苄明患者无明显血压波动。术后病理均为嗜铬细胞瘤。14例术后随访3个月～8年，血压正常，肿瘤无复发。结论综合分析实验室检查结果及影像学表现，可提高诊断意识；术前常规应用仅受体阻滞剂及扩容治疗，可提高手术安全性，减少并发症；后腹腔镜手术效果良好。

Objective To improve the diagnosis and treatment of occult pheochromocytoma of adrenal glands. Methods The clinical records of 15 cases of occult pheochromocytoma of adrenal glands were analyzed restrospectively. Among the cases, 6 cases were male and 9 cases were female. The average age was 41.5 years. They had no high blood pressure history. They were given B ultrosound, CT and labarotory examination before operation, 4 cases were diagnosed as nonfunctional adrenocortical tumor, 11 cases were occult pheochromocytoma of adrenal glands. Results 15 cases underwent operation, 9 cases open surgery and 6 cases retroperitoneal laparoscopic surgery. Fluctuation of blood pressure occurred during the operation in 10 cases. High blood pressure was controlled by nitroprusside, and low blood pressure by notepinephrin. Fluctuation of blood pressure occurred in 4 cases of suspicious adrenocortical tumor during the operation, fluctuation of blood pressure occurred during the operation in 6 of other 11 cases. Fluctuation of blood pressure did not occure in patients treated with phenoxybenzamine. The postoperative pathological diagnosis of these patients was pheochromcytoma without exception 14 cases were followed for 3 months to 8 years, the blood pressure of these 14 cases were nomal and the tumor had no metastasis. Conclusions Analyzing the results of labarotory examination and imaging examination could improve the accuracy of diagnosis and using receptor blocking agent and blood volume expander could raisee the safety of operation and decrease the complications. Retroperitoneal laparoscopic surgery is effective.