嗜铬细胞瘤诊疗：单中心142例报告

Diagnosis and treatment of pheochromocytoma： a single center case report of 142 cases

目的提高嗜铬细胞瘤的诊疗水平。方法回顾性分析2002年8月至2010年2月手术治疗的142例患者145例次病理确诊嗜铬细胞瘤临床资料，并对术后近期高血压恢复情况及远期肿瘤复发情况进行随访。肿瘤直径1．3～18．0cm，平均5．9cm，位于肾上腺内的单发肿瘤117例，双侧肿瘤10例，异位肿瘤10例，肾上腺及肾上腺外同时存在肿瘤5例。有典型儿茶酚胺症状者98例（69．0％），隐匿型嗜铬细胞瘤44例（31．0％）。术前给予酚苄明或甲磺酸多沙唑嗪准备1周以上。142例患者行手术145例次，开放手术91例次，腹腔镜54例次。结果142例术后病理均为嗜铬细胞瘤，其中良性83例、恶性23例、可疑恶性36例。术中血压骤增与术前血儿茶酚胺水平相关，与术前血压、术前应用α受体阻滞剂时间长短及肿瘤大小无关。术后高血压症状缓解87例，11例仍需药物控制血压。围手术期死亡1例。术后91例随访3～96个月，中位时间46个月，复发转移10例，其中5年内死于肿瘤复发转移6例。结论嗜铬细胞瘤确诊主要依据临床表现、生化定性检查及影像学定位检查，手术切除肿瘤是嗜铬细胞瘤的根治方法，对于术前血儿茶酚胺水平明显升高的患者更应警惕术中血压变化，术前应给予更充分的准备。

Objective To review the experience in diagnosis and treatment of pheochromocytoma in a single center. Methods A total number of 142/145 pheochromoeytoma cases treated surgi cally in our institute from August 2002 to February 2010 were retrospectively reviewed. The mean diameter of tumor was 5. 9 em （1. 3-- 18. 0 cm）. The majority of the tumors （92. 9%） were adrenal pheochromocytomas. Ninety eight patients （69.0 % ） presented initially with hypertension,whereas 44 patients （31~）presented with adrenal incidentaloma. A specific anti-hypertensive pre-surgery preparation with phenoxybenzamine or doxazosine mesylate was started over 1 week before the operation. Of the 142 patients, 91 accepted open surgery, 54 accepted laparoscopic surgery, of which, 5 converted from laparoscopic surgery to open surgery. Results Histopathological results showed that all the cases were pheoehromoeytoma, while 83 cases were benign, 23 cases were malignant and 37 cases were suspected malignant. Sudden rising of blood pressure during operation was related to the preop- erative serum level of cateeholamine. Eighty-seven of 98 patients with preoperative hypertension had normal postoperative blood pressure; the remaining 11 patients reduced the dosage of anti hyperten sion medication postoperatively. During the follow up of 3--96 months （median 46 months）, 10 of 91 patients had a recurrence or metastasis. Six patients died of recurrences or metastasis within 5 years. Conclusions The procedures of qualitative and locative diagnosis of phechromoeytoma include clinical manifestations, biochemical tests and imaging investigation. Surgical excision is the fundamental treatment for cure. Patients with high serum level of catecholamine tend to have a sudden rising of blood pressure during operation. Preoperative management is extremely important for the safety of the pa-tient. Intensive follow up is necessary.