嗜铬细胞瘤临床诊治经验（附43例报告）
发布时间：2018-07-14 12:16
【摘要】：目的嗜铬细胞瘤是一种少见的神经内分泌肿瘤,其具有多样化的临床表现,最常表现为头痛、大汗、心悸和高血压。嗜铬细胞瘤患者常常具有复杂的、潜在致命的心血管疾病或者其他并发症,尤其在麻醉和手术操作时,刺激肿瘤会导致大量的儿茶酚胺释放进入循环血液中,从而导致患者死亡。本研究的目的是提高对嗜铬细胞瘤的认识以及提供围手术期治疗的参考依据。方法收集2012年1月至2016年12月于山东省立医院泌尿微创外科行手术治疗并经术后组织学病理确诊的嗜铬细胞瘤病例43例,其中男24例(55.81%),女19例(44.19%),年龄11-74岁,平均年龄45.21 ±14.40岁。高血压病史0-18年。肿瘤位于左侧肾上腺14例(32.56%);位于右侧肾上腺19例(44.19%);双侧肾上腺2例(4.65%);腹膜后嗜铬细胞瘤8例(18.60%)。通过回顾性分析患者临床表现及症状、生化及影像学检查、手术治疗及术后治疗等相关指标,按预制定的表格摘录研究内容描述统计,运用t检验、卡方检验等统计学方法进行分析总结,以提高嗜铬细胞瘤诊治水平,降低患者围手术期并发症发生率及死亡率结果 43例患者均经手术切除肿瘤,其中腹腔镜手术41例(95.34%),手助腹腔镜手术1例(2.33%),开放性手术1例(2.33%)。患者中有高血压病史及症状(心悸、头晕、大汗)23例(53.49%),其中阵发性血压升高15例(34.88%),持续性高血压阵发加重8例(18.60%)。术前行B超、CT、MRI定位诊断符合率100%,CT定性诊断符合率为69.23%,MRI定性诊断符合率83.33%,两者比较差异无统计学意义(P0.05)。术前均使用a受体拮抗剂酚倫明(5mg q8h,视情况逐渐增加至30mgq8h)并同时使用复方右旋糖酐40注射液(500mlivdripqd)补液扩容治疗,其中对于心率90次/分患者加用美托洛尔缓释片(倍他乐克)控制心率12例(27.91%),对于血压140/90mmHg的患者加用钙离子通道阻滞剂氨氯地平或硝苯地平缓释片控制血压25例(58.14%)。术前使用α受体拮抗剂时间6-33天,平均15.95±6.11天,术前α受体拮抗剂使用时间长度与术中血压波动无关(P0.05)。术前血压稳定在140/130～90/80mmHg左右,心率90次/分,无阵发性血压升高,无心悸、头晕、大汗等明显现象,血细胞比容43.00%或者下降3.35±2.31%。其中12例(27.91%)伴血糖代谢异常,常规胰岛素注射或口服降糖药控制血糖水平使其稳定。术中出现血压波动患者16例(37.21%),可能与术前最高收缩压较高及肿瘤体积较大有关,全部患者平均手术时间64.78±12.32min。术后入重症监护室(ICU)行监测患者29例(67.44%),10例(23.26%)患者术后出现低血压现象,给予去甲肾上腺素输注,血压平稳,无一例患者术后出现严重低血糖现象。术后平均住院时间9.83±2.21天。结论腹腔镜手术已成为嗜铬细胞瘤切除的主要术式。嗜铬细胞瘤患者经术前明确诊断后,给予充分的术前准备,包括扩容降压和合并症的处理等,是保证患者手术平稳安全的基础。术中给予监测血压、心率等生命体征,及时处理突发情况及减少刺激肿瘤可保证手术的平稳运行。术后密切监测心率、血压等生命体征,及时对症治疗可明显减少心血管及其他并发症。
[Abstract]:Pheochromocytoma is a rare neuroendocrine tumor with a variety of clinical manifestations, most often characterized by headaches, sweating, palpitations, and hypertension. Pheochromocytoma often has complex, potentially fatal cardiovascular diseases or other complications, especially during anesthesia and operation, which can lead to a large number of tumors. The purpose of this study was to improve the understanding of pheochromocytoma and to provide a reference for perioperative treatment. Methods from January 2012 to December 2016, hand surgery in the urinary minimally invasive surgery, Shangdong Province-owned Hospital, and histologically confirmed pathologically after operation were collected. There were 43 cases of chromacytoma, including 24 males (55.81%) and 19 women (44.19%). The age was 11-74 years old and the average age was 45.21 + 14.40 years. The history of hypertension was 0-18 years. The tumor located in 14 cases (32.56%) in the left adrenal gland, 19 in the right adrenal gland, bilateral adrenal glands in 2 cases, and retroperitoneal pheochromocytoma. Clinical manifestations and symptoms, biochemical and imaging examinations, surgical treatment and post-operative treatment were used to describe the contents and statistics according to the pre made table excerpts. T test, chi square test and other statistical methods were used to improve the diagnosis and treatment of pheochromocytoma and reduce the incidence of complications and mortality in the perioperative period. 41 cases (95.34%), 1 cases (2.33%) and 1 open surgery (2.33%) were performed by laparoscopy, and 23 cases (53.49%) had the history and symptoms of hypertension (palpitation, dizziness, sweating), among which there were 15 cases (34.88%) of paroxysmal blood pressure, 8 cases (18.60%) of persistent hypertension (18.60%). The diagnostic coincidence rate of B-ultrasound, CT and MRI was 100%, the coincidence rate of CT qualitative diagnosis was 69.23%, and the coincidence rate of qualitative diagnosis of MRI was 83.33%. There was no significant difference between the two groups (P0.05). The a receptor antagonist phenolamin (5mg Q8H, increasing to 30mgq8h) before operation was used and Compound Dextran 40 Injection (500mlivdripqd) reexpansion was used at the same time. In the treatment, 12 cases (27.91%) were controlled by metoprolol sustained release tablets (Betaloc) and 90 cases of heart rate (27.91%). 25 cases (58.14%) were used with calcium ion channel blocker amlodipine or Extended Release Nifedipine Tablets to control blood pressure in patients with blood pressure (58.14%). The average time of alpha receptor antagonist was 15.95 + 6.11 days before operation, with the time of 6-33 days of alpha receptor antagonist. The length of pre operation alpha receptor antagonist was not related to the fluctuation of blood pressure during operation (P0.05). The preoperative blood pressure was around 140/130 to 90/80mmHg, heart rate was 90 / P, no paroxysmal blood pressure, no palpitations, dizziness, sweat and other obvious phenomena, blood cell specific volume was 43% or 3.35 + 2.31%., of which 12 cases (27.91%) with abnormal glucose metabolism, conventional pancreas Islet injection or oral hypoglycemic drug control blood glucose level to stabilize the blood glucose level. 16 cases (37.21%) of patients with fluctuation of blood pressure during the operation may be related to higher systolic pressure and larger tumor volume before operation. The average operation time of all patients is 64.78 + 12.32min. after operation in intensive care unit (ICU), 29 cases (67.44%), 10 (23.26%) patients after operation. There was hypotension, norepinephrine infusion was given, blood pressure was stable, no severe hypoglycemia was found in one patient after operation. The average time of hospitalization was 9.83 + 2.21 days after operation. Conclusion laparoscopy has become the main operation of pheochromocytoma resection. Patients with pheochromocytoma are given sufficient preoperative preparation after the preoperative diagnosis. It is the basis of ensuring the stable and safe operation of patients, including monitoring blood pressure, heart rate and other life signs, dealing with sudden situation in time and reducing stimulation of tumor to ensure the smooth operation of the operation. Other complications.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.6
本文编号：2121614
[Abstract]:Pheochromocytoma is a rare neuroendocrine tumor with a variety of clinical manifestations, most often characterized by headaches, sweating, palpitations, and hypertension. Pheochromocytoma often has complex, potentially fatal cardiovascular diseases or other complications, especially during anesthesia and operation, which can lead to a large number of tumors. The purpose of this study was to improve the understanding of pheochromocytoma and to provide a reference for perioperative treatment. Methods from January 2012 to December 2016, hand surgery in the urinary minimally invasive surgery, Shangdong Province-owned Hospital, and histologically confirmed pathologically after operation were collected. There were 43 cases of chromacytoma, including 24 males (55.81%) and 19 women (44.19%). The age was 11-74 years old and the average age was 45.21 + 14.40 years. The history of hypertension was 0-18 years. The tumor located in 14 cases (32.56%) in the left adrenal gland, 19 in the right adrenal gland, bilateral adrenal glands in 2 cases, and retroperitoneal pheochromocytoma. Clinical manifestations and symptoms, biochemical and imaging examinations, surgical treatment and post-operative treatment were used to describe the contents and statistics according to the pre made table excerpts. T test, chi square test and other statistical methods were used to improve the diagnosis and treatment of pheochromocytoma and reduce the incidence of complications and mortality in the perioperative period. 41 cases (95.34%), 1 cases (2.33%) and 1 open surgery (2.33%) were performed by laparoscopy, and 23 cases (53.49%) had the history and symptoms of hypertension (palpitation, dizziness, sweating), among which there were 15 cases (34.88%) of paroxysmal blood pressure, 8 cases (18.60%) of persistent hypertension (18.60%). The diagnostic coincidence rate of B-ultrasound, CT and MRI was 100%, the coincidence rate of CT qualitative diagnosis was 69.23%, and the coincidence rate of qualitative diagnosis of MRI was 83.33%. There was no significant difference between the two groups (P0.05). The a receptor antagonist phenolamin (5mg Q8H, increasing to 30mgq8h) before operation was used and Compound Dextran 40 Injection (500mlivdripqd) reexpansion was used at the same time. In the treatment, 12 cases (27.91%) were controlled by metoprolol sustained release tablets (Betaloc) and 90 cases of heart rate (27.91%). 25 cases (58.14%) were used with calcium ion channel blocker amlodipine or Extended Release Nifedipine Tablets to control blood pressure in patients with blood pressure (58.14%). The average time of alpha receptor antagonist was 15.95 + 6.11 days before operation, with the time of 6-33 days of alpha receptor antagonist. The length of pre operation alpha receptor antagonist was not related to the fluctuation of blood pressure during operation (P0.05). The preoperative blood pressure was around 140/130 to 90/80mmHg, heart rate was 90 / P, no paroxysmal blood pressure, no palpitations, dizziness, sweat and other obvious phenomena, blood cell specific volume was 43% or 3.35 + 2.31%., of which 12 cases (27.91%) with abnormal glucose metabolism, conventional pancreas Islet injection or oral hypoglycemic drug control blood glucose level to stabilize the blood glucose level. 16 cases (37.21%) of patients with fluctuation of blood pressure during the operation may be related to higher systolic pressure and larger tumor volume before operation. The average operation time of all patients is 64.78 + 12.32min. after operation in intensive care unit (ICU), 29 cases (67.44%), 10 (23.26%) patients after operation. There was hypotension, norepinephrine infusion was given, blood pressure was stable, no severe hypoglycemia was found in one patient after operation. The average time of hospitalization was 9.83 + 2.21 days after operation. Conclusion laparoscopy has become the main operation of pheochromocytoma resection. Patients with pheochromocytoma are given sufficient preoperative preparation after the preoperative diagnosis. It is the basis of ensuring the stable and safe operation of patients, including monitoring blood pressure, heart rate and other life signs, dealing with sudden situation in time and reducing stimulation of tumor to ensure the smooth operation of the operation. Other complications.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.6
【参考文献】
相关期刊论文 前2条
1 Simone Maurea;Pier Paolo Mainenti;Valeria Romeo;Carmine Mollica;Marco Salvatore;;Nuclear imaging to characterize adrenal tumors: Comparison with MRI[J];World Journal of Radiology;2014年07期
2 胡波;金讯波;孟慧林;王绪雷;王翰博;陈辑;;经腹腹腔镜肾上腺嗜铬细胞瘤切除术(附17例报告)[J];泌尿外科杂志(电子版);2013年01期
，本文编号：2121614
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