高强度聚焦超声消融术治疗伴心血管并发症的肾上腺肿瘤患者5例报告

Ablation with high-intensity focused ultrasound for adrenal adenoma complicated with cardiovascular diseases: a report of 5 cases

目的探讨高强度聚焦超声(HIFU)消融术治疗合并心血管并发症肾上腺肿瘤患者的有效性和安全性。方法对5例伴有心血管并发症的功能性肾上腺肿瘤患者(共5个病灶)进行HIFU消融术,其中嗜铬细胞瘤伴儿茶酚胺性心肌病1例,原发性醛固酮增多症伴高血压病或腺瘤伴高血压病各2例。结果 5例肾上腺肿瘤患者均顺利完成HIFU消融术,术中及术后均无严重并发症。2例较小病灶完全性坏死,2例病灶90%以上坏死,1例(嗜铬细胞瘤)病灶经两次消融后达到部分坏死。1例合并茶酚胺性心肌病嗜铬细胞瘤患者术后心脏缩小、心功能明显改善;4例并发高血压的肾上腺肿瘤患者中,2例血压恢复正常,2例降压药用药减少且血压控制良好。结论 HIFU消融术能实现安全、有效、无创地消融肾上腺肿瘤,从而缓解相关心血管并发症。

Objective To evaluate the feasibility and safety of ablation with high-intensity focused ultrasound（ HIFU） in patients with adrenal adenoma complicated with cardiovascular diseases. Methods Five patients（ 5 lesions） with functional adrenal adenoma complicated with cardiovascular diseases underwent ablation with HIFU. One patient was diagnosed as pheochromocytoma complicated with catecholamine-induced cardiomyopathy,two patients as primary aldosteronism complicated with hypertension,and the other two patients as adrenal adenoma complicated with hypertension. Results Ablation with HIFU was successfully completed in the five patients,and no severe complications occurred during or after operation. Complete necrosis was observed in two lesions with smaller volume,and the range of necrosis was more than 90% in two lesions.Partial necrosis was found in one patient with pheochromocytoma after two sessions of ablation. The cardiac volume reduced and cardiac function was improved significantly in one patient with pheochromocytoma complicated with catecholamine-induced cardiomyopathy after operation.Of four patients with adrenal adenoma complicated with hypertension,normal blood pressure was observed in two cases,and fewer anti-hypertensive medicines and well-controlled blood pressure in other two cases. Conclusion Ablation with HIFU is an effective and safe approach for noninvasive ablation of adrenal adenoma,thereby relieving the related cardiovascular complications.