肾上腺嗜铬细胞瘤自发性破裂大出血一例并文献复习

Spontaneous rupture of adrenal pheochromocytoma: case report and literature review

目的探讨如何快速诊断肾上腺嗜铬细胞瘤自发破裂,提高对肾上腺嗜铬细胞瘤自发破裂的救治,降低相关并发症的发生及病死率。方法对1例肾上腺嗜铬细胞瘤自发破裂大出血急诊患者的临床诊治、影像学特点结合国内外相关文献进行分析。结果以急腹症发病,有一过性高血压病史,伴交感神经兴奋现象,同时有失血性休克表现;B超或CT提示肾上腺肿物伴腹膜后、肾周血肿。结论急诊手术干预死亡率高,血流动力学不稳定和误诊是独立危险因素,条件允许可在动脉栓塞止血后择期手术治疗。

Objective To explore how to diagnose spontaneous rupture of adrenal pheochromocytoma rapidly,improve the treatment of adrenal pheochromocytoma spontaneous rupture and reduce the incidence of related complications and mortality rate. Methods The clinical diagnosis and treatment and the characteristics of imaging of a case of adrenal pheochromocytoma with spontaneous rupture and hemorrhage were analyzed by combining with the domestic and foreign related literature. Results The patient showed the characteristics such as acute abdomen, a history of hypertension with sympathetic nerve excitement, as well as the hemorrhagic shock performance. B-mode ultrasound or CT suggested adrenal tumor with retroperitoneal, perirenal hematoma. Conclusion Immediate surgery is associated with a high mortality rate. Hemodynamic instability and misdiagnosis are the powerful predictors of mortality. Transcatheter arterial embolization（TAE） should be the first treatment option in the attempt to achieve hemostasis before surgery.