原发性腹膜后肾上腺外嗜铬细胞瘤的诊断与治疗探讨(附5例报告)

Diagnosis and treatment of primary retroperitoneal external adrenal pheochromocytoma—A report of 5 cases

目的 探讨原发性腹膜后肾上腺外嗜铬细胞瘤的诊断和治疗经验。方法 回顾性分析5例原发性腹膜后肾上腺外嗜铬细胞瘤诊治经过。均行手术治疗 ,4例术中切除瘤体 ,并安置银夹 ,其中 1例在美蓝注入瘤体血管染色指导下手术 ,1例 2次手术。结果 1例术前诊断不明确 ,准备不充分 ,术中死亡。后 4例术前诊断明确 ,准备充分 ,术中血压稳定 ,完整切除肿瘤 ,其中美蓝染色指导下 1例手术时间缩短 ,出血少。随访中 ,1例无症状患者行CT检查时于银夹标记部位发现肿瘤复发 ,及时 2次手术 ,病理提示恶性。结论 重视原发性腹膜后肾上腺外嗜铬细胞瘤的术前定性、定位诊断 ,术中美蓝注入瘤体血管染色能指导手术 ,安置银夹标记值得采用和推广。

Objective To investigate the experience in diagnosis and treatment of primary retroperitoneal external adrenal pheochromocytoma. Methods Diagnosis and treatment of 5 cases of primary retriperitoneal external adrenal pheochromocytoma were analyzed retrospectively. All 5 cases were treated surgically. Tumor was resected and silver clips were put in during operation in 4 cases. One case underwent operation under the guidance of methylene blue injected into supplying artery of tumor. One case received surgical operation twice. Results Diagnosis of 1 case was undefined before operation and the patients died due to inadequate preparation during operation. The remaining 4 cases were correctly diagnosed with adequate preparation before operation and stable blood pressure during operation and the tumor was perfectly resected. Of the 4 cases, 1 case received operation under the guidance of methylene blue injected into supplying artery of tumor, resulting in less bleeding and short time during operation. During follow up, tumor recurrence was found in localization of silver clips in one case by CT examination. Conclusions Local and qualitative diagnosis before operation and injection of methylene blue into supplying artery as a mark during operation are of valuable to be adopted and populariazed.