妊娠合并嗜铬细胞瘤的临床诊治探讨(附4例报告)

Diagnosis and treatment of pheochromocytoma during pregnancy(Report of four cases)

目的：探讨妊娠合并嗜铬细胞瘤的临床诊断与治疗。方法：回顾性分析在我院诊治的4例妊娠合并嗜铬细胞瘤患者的临床资料。患者年龄分别为41、28、32和30岁,就诊时间为孕32、12、14和13周,所有患者均表现为妊娠期高血压,伴头痛、心悸、多汗。内分泌检查提示：24h尿儿茶酚胺明显升高。超声和MRI提示肾上腺区肿瘤,其中右侧肾上腺2例,左侧肾上腺1例,双侧肾上腺l例。肿瘤直径4.4~9.1cm,平均6.03cm。结果：1例患者于孕32周在全麻下行剖宫产术,顺利产一健康女婴,同时行腹腔镜右侧肾上腺嗜铬细胞切除术。2例患者选择流产,经充分药物准备后行腹腔镜肾上腺嗜铬细胞瘤切除术。1例选择流产,并拒绝进一步治疗。3例手术患者的术后病理均证实为嗜铬细胞瘤。结论：妊娠期具有典型的高血压,伴头痛、心悸、大汗三联征,应考虑到嗜铬细胞瘤的可能。早期诊断可显著降低母亲及胎儿病死率。治疗应根据妊娠所处的时期及嗜铬细胞瘤的功能状态选择恰当的方式。妊娠中期是较理想的手术治疗时机,腹腔镜手术治疗妊娠期嗜铬细胞瘤安全有效。

Objective：To investigate the diagnosis and treatment of pheochromocytoma during pregnancy.Method：The data of four cases of pheochromocytoma were analyzed retrospectively.All patients had hypertension during pregnancy,accompanied by headache,dizziness,palpitation and sweating.Endocrine test showed high 24-h catecholamine level in urine.Ultrasound and MRI confirmed the diagnosis of pheochromocytoma.The tumors located in the right adrenal gland in two cases,left adrenal in one case,and bilateral adrenal in one case.The tumor diameter ranged from 4.4to 9.1cm（mean,6.03cm）.Result：One of them had cesarean section at 32 weeks of gestation under general anesthesia,and a healthy baby girl was delivered smoothly.Laparoscopic resection of the right adrenal pheochromocytoma was performed at the same time,and an adrenal tumor of 7.0cm was resected successfully.Two other cases chose abortion,and laparoscopic resection of pheochromocytoma was performed.The rest one chose abortion,and refused further treatment.Histopathology confirmed the diagnosis of pheochromocytoma in three cases after laparoscopic surgery.Conclusion：Early diagnosis can reduce the maternal and fetal mortality significantly.Treatment should be chosen based on the period of gestation and functional state of the pheochromocytoma.Second trimester of pregnancy is the ideal time for surgical treatment.Laparoscopic resection of pheochromocytoma during pregnancy is safe and effective.