选择性动脉栓塞在嗜铬细胞瘤手术中的应用

Selective arterial embolization in giant pheochromocytoma

目的探讨选择性动脉栓塞在手术切除复杂血供的嗜铬细胞瘤中的作用。方法回顾性分析2000年1月至2010年7月我院收治的6例术前进行选择性动脉栓塞的嗜铬细胞瘤患者的临床资料。术前内分泌及影像学检查支持嗜铬细胞瘤诊断。分析患者的临床资料、栓塞过程、手术过程、相关并发症和随访结果。结果6例均为单发性嗜铬细胞瘤，其中位于肾上腺区4例、肾上腺外2例。肿瘤直径7～16cm，平均8．7cm，CT血管成像可见肿瘤多血供来源。6例均于术前行选择性动脉栓塞，栓塞前进行药物扩容及胃肠道准备，栓塞后24h内通过开放手术切除肿瘤。麻醉过程及手术过程中6例均未出现明显的血压波动。6例均未出现与栓塞及手术相关的严重并发症。6例病理结果与术前相符，术后血压正常，未见肿瘤复发。结论对复杂血供的嗜铬细胞瘤术前行选择性动脉栓塞是安全可行的。药物扩容、充分的胃肠道准备，选择栓塞后24h内进行手术减少了与栓塞相关的并发症。对复杂血供的嗜铬细胞瘤行选择性动脉栓塞有效地避免了嗜铬细胞瘤术中的血压波动，有利于完整切除体积巨大、血供复杂的肿瘤。

Objective To discuss the value （TAE） in surgery for giant pheochromocytoma. of preoperative transcatheter arterial embolization Methods During the period of Jan 2000 to July 2010, six patients with giant pheochromocytoma underwent preoperative TAE in Peking Union Medical College Hospital. The medical records were reviewed retrospectively. Results The lesions were all solitary giant pheochromocytoma. In four casesthe pheochromocytoma was located in the aderenal gland the remaining two cases were paraganglioma. The tumor size ranged from 7 cm to 16 cm. And CTA showed the masses were well vascularized and fed by diverse arteries. All six patients underwent preoperative TAE successfully and surgical removal was successfully performed within 24 hours after embolization. No major complications occurred. After surgery no patient suffered recurrence and clinical symptoms were significantly improved. Conclusions Preoperative TAE is safe and effective for giant pheochromocytoma. Preoperative pharmacological management, gastrointestinal preparation and surgical removal performed within 24 hours after embolization markedly reduced the complications related to embolization. TAE can help achieve hemodynamic stability during operation and is very helpful to a complete resection of giant pheochromocytomas.