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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 improve the diagnosis and treatment of bladder pheochromocytoma. Methods Seven patients with cystal pheochromocytoma had hypertension in 5 cases, of which 4 cases were attacked during urination and 3 cases of intermittent gross hematuria. 5 cases of bladder tumor found by B-ultrasound, 6 cases of submucosal cystoscopy tumor; 2 cases of urinary VMA increased. Preoperative diagnosis of 2 cases, oral α-blockers for 2 weeks. Seven patients underwent open surgery under epidural anesthesia, 6 underwent partial bladder resection, and 1 underwent bladder partial resection plus ureteric bladder replantation. The intraoperative blood pressure fluctuated in 2 cases. Results Six cases were diagnosed as bladder pheochromocytoma by routine routine pathology, one case was diagnosed by intraoperative rapid frozen section and immunohistochemistry. Follow-up 1 to 10 years, 1 case 2 years after the transfer, the diagnosis of malignant pheochromocytoma, the other 6 cases of normal blood pressure, no tumor recurrence. Conclusions The triad of typical episodes of hematuria, hypertension and micturition are the main symptoms of bladder pheochromocytoma. The diagnosis can be made by using B-ultrasound, CT, MRI and 13 1I MIBG. Urinary VMA and urinary catecholamines can be diagnosed qualitatively. Surgical resection is the preferred treatment, should be followed up after surgery.