Dugas Geoff, Fuller John, Singh Sudha, Watson James
Department of Anesthesia and Perioperative Medicine, St. Joseph's Health Care, University of Western Ontario, London, Ontario, Canada.
Can J Anaesth. 2004 Feb;51(2):134-8. doi: 10.1007/BF03018772.
To describe a patient diagnosed with pheochromocytoma in the third trimester of pregnancy and discuss the perioperative and anesthetic management.
A 32-yr-old previously healthy woman (gravida 4, para 2) presented to our tertiary care obstetrical hospital at 34 weeks five days gestation with a history of labile blood pressure and severe hypertension. A week prior to admission she began having episodes of severe headache, dizziness, sweating and nausea. On a routine obstetric visit she was noted to be severely hypertensive with a blood pressure of 200/120 mmHg. Biochemical investigations confirmed the diagnosis of pheochromocytoma and magnetic resonance imaging demonstrated a 3 cm x 3 cm right adrenal mass. The patient was invasively monitored in the intensive care unit and treated with alpha- followed by beta-blockade with phenoxybenzamine and metoprolol. A multidisciplinary conference was organized involving endocrinology, anesthesiology, general surgery and obstetrics to determine the most appropriate management of the patient. An uncomplicated laparoscopic adrenalectomy was performed following a period of recovery after an uneventful elective Cesarean delivery.
The primary goals in the management of pheochromocytoma in pregnancy are early diagnosis, avoidance of a hypertensive crisis during delivery and definitive surgical treatment. Timing of surgical resection will depend on the gestational age at which diagnosis is made. Cesarean section is the preferred mode of delivery when the tumour is still present. This case illustrates that with antenatal diagnosis, advanced methods of tumour localization, adequate preoperative adrenergic blockade and team planning, pheochromocytoma in pregnancy can be treated successfully.
描述一名在妊娠晚期被诊断为嗜铬细胞瘤的患者，并讨论围手术期及麻醉管理。
一名32岁、既往健康的女性（孕4产2），在妊娠34周零5天时入住我院三级护理产科医院，有血压波动及重度高血压病史。入院前一周，她开始出现严重头痛、头晕、出汗及恶心症状。在一次常规产科检查中，发现她血压极高，达200/120 mmHg。生化检查确诊为嗜铬细胞瘤，磁共振成像显示右侧肾上腺有一个3 cm×3 cm的肿块。患者在重症监护病房接受有创监测，并先用苯氧苄胺进行α受体阻断，随后用美托洛尔进行β受体阻断治疗。组织了一次多学科会诊，参与人员包括内分泌科、麻醉科、普通外科及产科，以确定对该患者最合适的治疗方案。在择期剖宫产顺利完成并恢复一段时间后，进行了一次无并发症的腹腔镜肾上腺切除术。
妊娠合并嗜铬细胞瘤的治疗主要目标是早期诊断、避免分娩期间发生高血压危象以及进行确定性手术治疗。手术切除的时机将取决于作出诊断时的孕周。当肿瘤仍然存在时，剖宫产是首选的分娩方式。本病例表明，通过产前诊断、先进的肿瘤定位方法、充分的术前肾上腺素能阻断及团队规划，妊娠合并嗜铬细胞瘤可得到成功治疗。
