肾上腺嗜铬细胞瘤和副神经节瘤98例临床分析

Clinical analysis of 98 cases of adrenal pheochromocytoma /paraganglioma

目的总结分析98例嗜铬细胞瘤和副神经节瘤(pheochromocytoma and paraganglioma,PPGL)患者的临床特点,以期提高PPGL的诊治水平。方法回顾性分析2018-01—2020-12在郑州大学第一附属医院手术治疗且经术后病理结果诊断为PPGL的患者的临床资料。采用单因素及多因素Logistics分析患者的症状、激素水平、肿瘤部位和大小等与术中血压波动的相关因素。结果98例患者中,男42例(42.9%),女56例(57.1%);年龄(47.16±15.4)岁,最高年龄段为≥51岁(P<0.05)。82例首诊于泌尿外科(83.7%),最常见的原因是在影像学检查中发现肾上腺或其他部位占位病变(72例,73.5%)。74例(75.5%)PPGL位于肾上腺,24例(24.5%)位于肾上腺外。术前有高血压49例(50%)。67例(68.4%)患者术中血压出现波动,31例(31.6%)无血压波动。术中血压波动与肿瘤大小(P=0.039)、年龄(P=0.016)有相关性。结论大部分PPGL患者初发症状不明显,最常见的就诊原因是在影像学检查中发现肾上腺或其他部位占位病变。对年龄较大及肿瘤较大的患者,应警惕术中出现血压波动,做好预备应对措施,以减少手术和并发症发生风险。

Objective The clinical characteristics of 98 patients with pheochromocytoma and paraganglioma(PPGL)were analyzed in order to improve the diagnosis and treatment of PPGL.Methods The clinical data of patients with postoperative PPGL in the first affiliated Hospital of Zhengzhou University from January 2018 to December 2020 were analyzed retrospectively.Univariate and multivariate Logistics analysis was used to study the correlation between symptoms,hormone level,tumor location,tumor size and blood pressure fluctuation during PPGL.Results Among the 98 patients with PPGL,there were 42 males(42.9%)and 56 females(57.1%).The average age of diagnosis was(47.16±15.4)years old,and the highest prevalence rate of PPGL was≥51 years old.82 cases were firstly diagnosed in the department of urology(83.7%).The most common reason was that the adrenal gland or other sites were found to occupy space in the imaging examination(72 cases,73.5%).PPGL was located in adrenal gland in 74 cases(75.5%)and outside adrenal gland in 24 cases(24.5%).49 cases(50%)had hypertension before operation.There were 67 patients(68.4%)with intraoperative blood pressure fluctuation and 31 patients(31.6%)without blood pressure fluctuation.The fluctuation of intraoperative blood pressure was correlated with the size of the tumor(0.039)and the age(0.016).Conclusion The initial symptoms of most patients are not obvious,and the most common reason is the occupation of adrenal gland or other parts.Older patients and patients with larger tumors should be more alert to the possibility of blood pressure fluctuation during operation and prepare countermeasures to reduce the risk of operation and complications.