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目的 总结嗜铬细胞瘤诊治体会。方法 测定患者血浆去甲肾上腺素 (NE)、肾上腺素 (E)、2 4h尿香草基苦杏仁酸 (VMA) ;做肿瘤CT扫描 ,同位素间位碘苄胍 (131I-MIBG)显像 ;口服酚苄明、心得安控制血压、心率 ,术前 3天置中心静脉导管 (置管 ) ,扩充血容量 (扩容 ) ;采用硬膜外加气管插管麻醉 ;胸、腹膜外十一肋间径路行肿瘤切除术。结果 NE、E、VMA升高 5 8例 ,占 89.2 %。CT扫描 5 4例 ,准确率 96 .3 %。131I-MIBG显像 5 5例 ,阳性率 10 0 %。术前未置管、扩容 12例 ,肿瘤切除后出现休克 ,其中 1例心跳骤停和 1例急性心衰均抢救成功 ;置管、扩容 5 3例 ,低血压 6例 ,补液后恢复正常。肿瘤包膜残留 5例 ,复发 2例 ,二次术后 1年死亡 ;4例恶性嗜铬细胞瘤根治术后存活 <3年 1例 ,>3年 3例。结论 本病诊断 ,术后随访首选测定NE、E、VMA ,行CT扫描和131I-MIBG显像。术前置管、扩容是预防术中低血容量休克 ,补液过量的关键。硬膜外加气管麻醉对控制血压波动及抢救十分有利。胸、腹膜外十一肋间径路暴露好 ,并发症少 ,适用巨大的、与大血管关系密切的嗜铬细胞瘤切除和腹膜后淋巴结清扫术。作者主张尽可能完整切除肿瘤并进行长期随访
Objective To summarize the experience of diagnosis and treatment of pheochromocytoma. Methods The plasma levels of norepinephrine (NE), epinephrine (E), 24 h urine vanillylamin acid (VMA) were measured. CT scans of tumor and 131 I-MIBG imaging were performed. Phenoxybenzamine, propranolol, blood pressure control, heart rate, 3 days before surgery to place central venous catheter (catheter), expansion of blood volume (expansion); epidural anesthesia with tracheal intubation; chest, extra- Tumor resection. Results The NE, E, VMA increased 58 cases, accounting for 89.2%. CT scan 54 cases, the accuracy rate of 96.3%. Fifty-five cases of 131I-MIBG imaging showed a positive rate of 100%. Preoperative catheterization, expansion in 12 cases, shock after tumor resection, including 1 case of cardiac arrest and 1 case of acute heart failure were successfully rescued; catheter, dilatation 53 cases, 6 cases of hypotension, fluid returned to normal. There were 5 cases of tumor capsule residue, 2 cases of recurrence and 1 year after the second operation. Survival of 4 cases of malignant pheochromocytoma was <3 years, 3 cases> 3 years. Conclusion The diagnosis of this disease, postoperative follow-up of the preferred determination of NE, E, VMA, CT scan and 131I-MIBG imaging. Preoperative catheter, dilatation is to prevent intraoperative hypovolemic shock, rehydration over the key. Epidural tracheal anesthesia is very beneficial for the control of blood pressure fluctuations and rescue. Thoracic and extraperitoneal 11 intercostal path exposure is good, less complications, for a huge, closely related to the large blood vessels of pheochromocytoma resection and retroperitoneal lymph node dissection. The authors advocate complete resection of the tumor and long-term follow-up