18例巨大嗜铬细胞瘤的手术治疗

The Surgical Treatment of 18 Patients with Enormous Pheochromocytoma

目的 提高巨大嗜铬细胞瘤的手术治疗水平。方法 总结分析1990年1月～2001年9月经手术和病理证实且直径大于10cm的18例巨大嗜铬细胞瘤患者的临床资料。结果18例巨大嗜铬细胞瘤占同期同类型肿瘤的13.6％,所有患者均接受手术治疗,术前药物控制血压2周～4月;B超、CT、Doppler超声、DSA或MRA检查定位决定手术径路及方案;术中平均输血2 450ml,2例采用自体血回输。17例患者完整切除肿瘤,1例仅作病理活检,术后病理均证实为嗜铬细胞瘤,其中1例伴不典型增生,2例提示有恶变倾向。随访8月～11年,2例复发再手术,结论 巨大嗜铬细胞瘤患者的术前准备时间较长,部分患者尚需联合用药方能较理想地控制高血压,准确的术前定位对选择手术径路、制定手术方案至关重要。

Objective To improve the diagnosis and treatment of enormous pheochromocytorna. Methods Eighteen patients with enormous pheochromocytomas exceeding 10cm in diameter treated surgically with pathological identification between 1990.1-2001.9 were reviewed retrospectively. Results Between 1990. 1-2001.9 the percentage of enormous pheochromocytomas was 13.6% in all pheochromocytomas. Before operation blood pressure was controlled with medication for 2 weeks to 4 months, B type ultrasonography, Doppler ultrasonography, CT, MRA, and DSA were used to formulate the surgical proposed and approach. Open surgery was undertaken in all 18 patients, and the tumors were extirpated in 17 cases, with one exception of exploratory biopsy. The average amount of blood transfused was 2 450 ml. Pheochromocytomas were pathologically proved in all cases, including 1 atypical plasia and 2 cases of malignant tendency. All patients have been followed up for 8 months to 11 years, with 2 cases of recurrence. Conclusion For enormous pheochromocytoma, preoperative preparation must be sufficient, and in some hypertensive patients it is necessary to control hypertension with combined drugs. Accurate preoperative location of the tumor is extremely important to design the surgical approach and scheme.