Fermandois Magdalena, Altamirano Jaime, Rojas Felipe, Román Cristóbal, Pinto Iván
Departamento de Anestesiología, Facultad de Medicina, Universidad de los Andes, Santiago, Chile. Email:
Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile.
Medwave. 2020 Mar 4;20(2):e7830. doi: 10.5867/medwave.2020.02.7830.
Pheochromocytomas and paragangliomas are rare neuroendocrine tumors, characterized by a high morbidity rate due to catecholamine excess. These high levels are independent of physiologic stressors. For the diagnosis, a biochemical workup is paramount. The most widely used are plasma-free metanephrines and urinary fractionated metanephrines. Imaging studies should be initiated once the biochemical diagnosis is established. Evaluation of the patient with pheochromocytomas and paragangliomas must be done taking into account the leading causes of perioperative morbidity and mortality. The two primary interventions that have reduced perioperative mortality are alpha-adrenergic blockade and intravascular volume normalization. Another significant advance has been the establishment of laparoscopic surgery as the gold standard for the surgical approach. No anesthetic technique has been found to be superior to another. Intraoperative hemodynamic instability has been correlated with poorer outcomes; thus one of the main intraoperative goals is maintaining hemodynamic stability. Lower morbidity and almost zero mortality rates due to preoperative and intraoperative management improvements have led to a focus on the immediate and long-term postoperative care. Anual lifelong follow-up is recommended to detect recurrent disease.
嗜铬细胞瘤和副神经节瘤是罕见的神经内分泌肿瘤，其特征是由于儿茶酚胺过量导致发病率较高。这些高水平与生理应激源无关。对于诊断，生化检查至关重要。最常用的是血浆游离甲氧基肾上腺素和尿分馏甲氧基肾上腺素。一旦确立生化诊断，就应开始进行影像学检查。对嗜铬细胞瘤和副神经节瘤患者的评估必须考虑围手术期发病和死亡的主要原因。降低围手术期死亡率的两项主要干预措施是α-肾上腺素能阻滞和血管内容量正常化。另一项重大进展是将腹腔镜手术确立为手术方法的金标准。尚未发现哪种麻醉技术优于另一种。术中血流动力学不稳定与较差的预后相关；因此，术中的主要目标之一是维持血流动力学稳定。由于术前和术中管理的改善，发病率降低且死亡率几乎为零，这导致人们将重点放在术后即刻和长期护理上。建议每年进行终身随访以检测复发性疾病。
