肾上腺嗜铬细胞瘤的诊断与手术治疗

Diagnosis and surgical management of adrenal gland pheochromocytoma

目的 :提高肾上腺嗜铬细胞瘤的诊断与外科治疗水平。方法 :对 10 9例经手术治疗的肾上腺嗜铬细胞瘤患者的临床资料进行回顾性分析 ,其中具有典型儿茶酚胺症临床表现者 10 4例 ,2 4h尿VMA定性检查 10 6例 ,99例增高 ,阳性率为 90 .8% ,B超、CT及MRI定位诊断阳性率分别为 89.0 %、92 .7%及 10 0 %。 10 6例经开放手术切除肿瘤 ,3例行后腹腔镜肿瘤切除术。结果 :经病理检查证实 ,良性 10 2例 (93.6 % ) ,恶性 7例 (6 .4 % ) ,本组无手术死亡病例。结论 :肾上腺嗜铬细胞瘤主要根据临床表现、生化定性检查及影像学定位检查明确诊断。手术切除肿瘤是唯一有效的措施 ,术前充分准备是确保手术成功的重要因素。

Purpose:To study and evaluate the diagnosis and treatment strategy of pheochromocytoma.Methods:109 Cases of pheochromocytoma diagnosed and treated between 1976 and 2001 were reviewed and studied:There were 104 cases with high blood catecholamine. Urinary Vanilly1 mandelic acid (VMA) was the best marker with a positive sensitivity rate of 90.8 %. The accurate localization rate of the tumors was 89.0 % for B ultrasohography, 92.7 % for CT and 100% for MRI.Results:Radical adrenalectomy was carried out for 106 cases and there were 3 cases with laparoscopic adrenalectomy. Operative therapy was successful in all cases. The diagnosis of all cases was confirmed by pathologic studies.102 cases ( 93.6 %) were benign and other 7 cases ( 6.4 % ) were malignant.Conclusions:The procedures of the qualitative and locative diagnosis of adrenal gland pheochromocytoma included clinical manifestations, urinary VMA assessment and imaging investigation. Surgical management was the only means for cure and preoperative preparation was extremely important. Laparoscopic adrenalectomy was safe and effective for managing adrenal gland pheochromocytoma.