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目的 提高儿茶酚胺症的诊断和治疗水平。 方法 报告 182例儿茶酚胺症患者的临床资料 ,其中嗜铬细胞瘤 173例 ,髓质增生 9例。临床表现为阵发性高血压 10 3例 (5 7% ) ,持续性高血压 6 9例 (38% ) ,血压正常 10例 (5 % )。 15 9例行尿VMA检查 ,异常 15 0例 (94% )。腹膜后充气造影 5 3例 ,阳性 46例 (87% ) ;B超检查 146例 ,阳性 133例 (91% ) ;CT检查 10 9例 ,阳性 10 3例 (95 % ) ;MRI检查 2 2例 ,均为阳性。 结果 182例均行手术治疗并经病理证实 ,良性 16 3例 (90 % ) ,恶性 19例 (10 % ) ;肿瘤位于肾上腺 15 1例 (83% ) ,异位嗜铬细胞瘤 2 2例 (12 % ) ,肾上腺髓质增生 9例 (5 % )。16 5例随访 1～ 2 4年 ,19例恶性嗜铬细胞瘤均死亡 ,余 146例中 12 9例 (88% )术后无需药物治疗 ,血压恢复正常。 17例 (12 % )术后仍需持续用药控制血压 ,其中多发性肿瘤 7例 ,肾上腺外肿瘤 4例 ,非儿茶酚胺依赖性高血压 6例。 结论 尿VMA检查是儿茶酚胺症定性诊断的主要依据 ,B超、CT、MRI检查为定位诊断的主要依据。根本治疗方法为手术切除 ,充分的术前准备和正确的围手术期处理十分重要。
Objective To improve the diagnosis and treatment of catecholamines. Methods The clinical data of 182 patients with catecholamine were reported, including 173 cases of pheochromocytoma and 9 cases of medullary hyperplasia. The clinical manifestations were paroxysmal hypertension in 103 cases (57%), persistent hypertension in 69 cases (38%) and normal blood pressure in 10 cases (5%). 15 9 routine urine VMA examination, abnormal 150 cases (94%). There were 53 cases of retroperitoneal inflatable angiography (46 cases) (87%), 146 cases of B ultrasound examination (133%), 109 cases of CT examination (103%) and 95% , Are positive. Results Totally 182 cases were surgically treated and confirmed by pathology. There were 16 3 (90%) benign and 19 malignant (10%) malignant tumors. The tumors were located in the adrenal gland in 15 1 cases (83%) and ectopic pheochromocytoma in 22 12%), adrenal medulla hyperplasia in 9 cases (5%). Sixteen cases of malignant pheochromocytoma died during the follow-up of 1 ~ 24 years. Of the remaining 146 cases, 129 (88%) did not need medical treatment and their blood pressure returned to normal. Seventeen patients (12%) needed continuous medication to control blood pressure after surgery, including 7 cases of multiple tumors, 4 cases of extra-adrenal tumors and 6 cases of non-catecholamine-dependent hypertension. Conclusions Urinary VMA examination is the main basis for the qualitative diagnosis of catecholamines. B-ultrasound, CT and MRI are the main basis of diagnosis. The fundamental treatment for surgical resection, adequate preoperative preparation and correct perioperative management is very important.