膀胱嗜铬细胞瘤的诊断与治疗

Diagnosis and treatment of pheochromocytoma in urinary bladder

目的 提高膀胱嗜铬细胞瘤的诊断和治疗水平。 方法 7例膀胱嗜铬细胞瘤患者中高血压 5例 ,其中 4例在排尿时发作 ;间歇性肉眼血尿 3例。 5例B超检查发现膀胱肿瘤 ,6例膀胱镜检查见黏膜下肿瘤 ;2例尿VMA升高。术前确诊 2例 ,口服α受体阻滞剂 2周。 7例均在硬膜外麻醉下行开放手术 ,6例行膀胱部分切除 ,1例行膀胱部分切除加输尿管膀胱再植术 ,术中血压波动 2例。 结果 6例经术后常规病理、1例经术中快速冰冻切片及免疫组织化学病理诊断为膀胱嗜铬细胞瘤。随访 1～ 10年 ,1例术后 2年转移 ,诊断为恶性嗜铬细胞瘤 ,其他 6例血压正常 ,无肿瘤复发。 结论 血尿、高血压和排尿时典型发作三联征为膀胱嗜铬细胞瘤的主要症状 ,可应用B超、CT、MRI、13 1I MIBG作定位诊断 ,尿VMA和尿儿茶酚胺作定性诊断。手术切除是首选治疗方法 ,术后应密切随访。

Objective To evaluate the approaches for diagnosis and treatment of pheochromocytoma in urinary bladder. Methods Seven cases of bladder pheochromocytoma were included.Hypertension was observed in 5 cases,of whom 4 had paroxysmal hypertension during urination.Intermittent macrohematuria was found in 3 cases.Bladder occupations were detected by B-ultrasound in 5 cases and bladder submucosal neoplasms were discovered with cystoscopy in 6 cases.Urine VMA was elevated in 2 cases.Two cases were preoperatively suspected of having bladder pheochromocytoma and took α-receptor blocker for 2 weeks.Partial cystectomy was performed in 6 cases,and partial cystectomy combined with ureterovesical anastomosis in 1. Results Of the 7 cases,6 were pathologically diagnosed as pheochromocytoma postoperatively,the other one was diagnosed by frozen-section sample during operation.During the 1 to 10 years' follow-up,one patient suffered from metastatic tumor 2 years after initial operation and this case was confirmed as malignant pheochromocytoma.The other 6 cases had normal blood pressure and no recurrent tumor developed. Conclusions The typical compsite symptoms of bladder pheochromocytoma consist of intermittent macrohematuria,hypertension and paroxysmal occurrence during micturition.B-ultrasound,CT,MRI and 131 I-MIBG scintigraphy have higher value in localizing the lesions.Urinary VMA and catecholamine detection is useful in quatitative diagnosis.Surgical excision of the tumor is the preferred management.Mesuring the level of urinary catecholamine can monitor the recurrence or metastasis of the tumor.