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目的:探讨妊娠合并嗜铬细胞瘤的临床诊断与治疗。方法:回顾性分析在我院诊治的4例妊娠合并嗜铬细胞瘤患者的临床资料。患者年龄分别为41、28、32和30岁,就诊时间为孕32、12、14和13周,所有患者均表现为妊娠期高血压,伴头痛、心悸、多汗。内分泌检查提示:24h尿儿茶酚胺明显升高。超声和MRI提示肾上腺区肿瘤,其中右侧肾上腺2例,左侧肾上腺1例,双侧肾上腺l例。肿瘤直径4.4~9.1cm,平均6.03cm。结果:1例患者于孕32周在全麻下行剖宫产术,顺利产一健康女婴,同时行腹腔镜右侧肾上腺嗜铬细胞切除术。2例患者选择流产,经充分药物准备后行腹腔镜肾上腺嗜铬细胞瘤切除术。1例选择流产,并拒绝进一步治疗。3例手术患者的术后病理均证实为嗜铬细胞瘤。结论:妊娠期具有典型的高血压,伴头痛、心悸、大汗三联征,应考虑到嗜铬细胞瘤的可能。早期诊断可显著降低母亲及胎儿病死率。治疗应根据妊娠所处的时期及嗜铬细胞瘤的功能状态选择恰当的方式。妊娠中期是较理想的手术治疗时机,腹腔镜手术治疗妊娠期嗜铬细胞瘤安全有效。
Objective: To investigate the clinical diagnosis and treatment of pheochromocytoma with pregnancy. Methods: The clinical data of 4 patients with pheochromocytoma during pregnancy were analyzed retrospectively. The patients were 41, 28, 32 and 30 years of age respectively. The visiting time was 32, 12, 14 and 13 weeks. All patients showed gestational hypertension, headache, palpitation and hyperhidrosis. Endocrine examination Tip: 24h urinary catecholamines increased significantly. Ultrasound and MRI suggest adrenal tumors, including 2 cases of the right adrenal gland, left adrenal in 1 case, bilateral adrenal in 1 case. Tumor diameter 4.4 ~ 9.1cm, an average of 6.03cm. Results: One patient underwent cesarean section under general anesthesia at the 32th week of pregnancy. One healthy baby girl was successfully delivered and the laparoscopic right adrenal chromaffin cell resection was performed at the same time. 2 patients were selected abortion, after adequate preparation of laparoscopic adrenal pheochromocytoma resection. 1 case of abortion, and refused to further treatment. Postoperative pathology of 3 surgical patients confirmed pheochromocytoma. Conclusion: The typical hypertension in pregnancy with headache, palpitations and hyperhidrosis should be considered. The possibility of pheochromocytoma should be considered. Early diagnosis can significantly reduce maternal and fetal mortality. Treatment should be based on the period of pregnancy and pheochromocytoma functional status to choose the right way. The second trimester of pregnancy is the ideal timing of surgery, laparoscopic surgery for pheochromocytoma pregnancy safe and effective.