嗜鉻細胞瘤臨床診治經(jīng)驗（附43例報告）
發(fā)布時間：2018-07-14 12:16
【摘要】：目的嗜鉻細胞瘤是一種少見的神經(jīng)內(nèi)分泌腫瘤,其具有多樣化的臨床表現(xiàn),最常表現(xiàn)為頭痛、大汗、心悸和高血壓。嗜鉻細胞瘤患者常常具有復(fù)雜的、潛在致命的心血管疾病或者其他并發(fā)癥,尤其在麻醉和手術(shù)操作時,刺激腫瘤會導(dǎo)致大量的兒茶酚胺釋放進入循環(huán)血液中,從而導(dǎo)致患者死亡。本研究的目的是提高對嗜鉻細胞瘤的認識以及提供圍手術(shù)期治療的參考依據(jù)。方法收集2012年1月至2016年12月于山東省立醫(yī)院泌尿微創(chuàng)外科行手術(shù)治療并經(jīng)術(shù)后組織學(xué)病理確診的嗜鉻細胞瘤病例43例,其中男24例(55.81%),女19例(44.19%),年齡11-74歲,平均年齡45.21 ±14.40歲。高血壓病史0-18年。腫瘤位于左側(cè)腎上腺14例(32.56%);位于右側(cè)腎上腺19例(44.19%);雙側(cè)腎上腺2例(4.65%);腹膜后嗜鉻細胞瘤8例(18.60%)。通過回顧性分析患者臨床表現(xiàn)及癥狀、生化及影像學(xué)檢查、手術(shù)治療及術(shù)后治療等相關(guān)指標(biāo),按預(yù)制定的表格摘錄研究內(nèi)容描述統(tǒng)計,運用t檢驗、卡方檢驗等統(tǒng)計學(xué)方法進行分析總結(jié),以提高嗜鉻細胞瘤診治水平,降低患者圍手術(shù)期并發(fā)癥發(fā)生率及死亡率結(jié)果 43例患者均經(jīng)手術(shù)切除腫瘤,其中腹腔鏡手術(shù)41例(95.34%),手助腹腔鏡手術(shù)1例(2.33%),開放性手術(shù)1例(2.33%)�；颊咧杏懈哐獕翰∈芳鞍Y狀(心悸、頭暈、大汗)23例(53.49%),其中陣發(fā)性血壓升高15例(34.88%),持續(xù)性高血壓陣發(fā)加重8例(18.60%)。術(shù)前行B超、CT、MRI定位診斷符合率100%,CT定性診斷符合率為69.23%,MRI定性診斷符合率83.33%,兩者比較差異無統(tǒng)計學(xué)意義(P0.05)。術(shù)前均使用a受體拮抗劑酚倫明(5mg q8h,視情況逐漸增加至30mgq8h)并同時使用復(fù)方右旋糖酐40注射液(500mlivdripqd)補液擴容治療,其中對于心率90次/分患者加用美托洛爾緩釋片(倍他樂克)控制心率12例(27.91%),對于血壓140/90mmHg的患者加用鈣離子通道阻滯劑氨氯地平或硝苯地平緩釋片控制血壓25例(58.14%)。術(shù)前使用α受體拮抗劑時間6-33天,平均15.95±6.11天,術(shù)前α受體拮抗劑使用時間長度與術(shù)中血壓波動無關(guān)(P0.05)。術(shù)前血壓穩(wěn)定在140/130～90/80mmHg左右,心率90次/分,無陣發(fā)性血壓升高,無心悸、頭暈、大汗等明顯現(xiàn)象,血細胞比容43.00%或者下降3.35±2.31%。其中12例(27.91%)伴血糖代謝異常,常規(guī)胰島素注射或口服降糖藥控制血糖水平使其穩(wěn)定。術(shù)中出現(xiàn)血壓波動患者16例(37.21%),可能與術(shù)前最高收縮壓較高及腫瘤體積較大有關(guān),全部患者平均手術(shù)時間64.78±12.32min。術(shù)后入重癥監(jiān)護室(ICU)行監(jiān)測患者29例(67.44%),10例(23.26%)患者術(shù)后出現(xiàn)低血壓現(xiàn)象,給予去甲腎上腺素輸注,血壓平穩(wěn),無一例患者術(shù)后出現(xiàn)嚴(yán)重低血糖現(xiàn)象。術(shù)后平均住院時間9.83±2.21天。結(jié)論腹腔鏡手術(shù)已成為嗜鉻細胞瘤切除的主要術(shù)式。嗜鉻細胞瘤患者經(jīng)術(shù)前明確診斷后,給予充分的術(shù)前準(zhǔn)備,包括擴容降壓和合并癥的處理等,是保證患者手術(shù)平穩(wěn)安全的基礎(chǔ)。術(shù)中給予監(jiān)測血壓、心率等生命體征,及時處理突發(fā)情況及減少刺激腫瘤可保證手術(shù)的平穩(wěn)運行。術(shù)后密切監(jiān)測心率、血壓等生命體征,及時對癥治療可明顯減少心血管及其他并發(fā)癥。
[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.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R736.6
本文編號：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.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R736.6
【參考文獻】
相關(guān)期刊論文 前2條
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;金訊波;孟慧林;王緒雷;王翰博;陳輯;;經(jīng)腹腹腔鏡腎上腺嗜鉻細胞瘤切除術(shù)(附17例報告)[J];泌尿外科雜志(電子版);2013年01期
，本文編號：2121614
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