Orchard T, Grant C S, van Heerden J A, Weaver A
Department of Surgery, Mayo Clinic, Rochester, MN 55905.
Surgery. 1993 Dec;114(6):1153-8; discussion 1158-9.
The management of pheochromocytoma has evolved through refinements in diagnosis, localization, and pharmacologic therapy for hemodynamic control both before and during operation. To provide a benchmark for comparison and to assess the feasibility of surgical resection using a posterior or laparoscopic approach, we reviewed the overall management and outcome of 110 patients who underwent primary resection of pheochromocytoma or paraganglioma between 1980 and January 1992 at the Mayo Clinic.
Patient records were reviewed for demographic information, associated conditions, symptoms, laboratory evaluation, localizing techniques, preoperative adrenergic blockade, intraoperative hemodynamics, tumor location, pathologic conditions, and outcome.
The most prominent symptoms included headaches, sweating, and palpitations. Forty-seven percent of patients had sustained hypertension, and classic paroxysmal attacks were present in 72%. The combination of urinary metanephrines and vanillylmandelic acid had a sensitivity of 98% in detecting the disease. The positive and negative predictive values for localization of tumors by computed tomography scan were 95% and 100%, respectively. With routine alpha- and beta-blockade, there were no complications associated with intraoperative hypertension. Perioperative mortality was less than 1% and morbidity was 16%. More than 90% of patients were restored to a condition of normotension; only 20% of these required medication.
Surgical resection of these tumors, via a transabdominal approach, can be accomplished safely and hospitalization usually extends a week. Today the diagnosis, localization, preoperative blockade, intraoperative hemodynamic control, and postoperative management have reached a level sufficient to permit either a posterior or laparoscopic approach, but only if they can be mastered technically.
嗜铬细胞瘤的治疗方法已通过诊断、定位以及手术前和手术期间血流动力学控制的药物治疗的改进而不断发展。为了提供一个比较基准并评估采用后路或腹腔镜手术切除的可行性，我们回顾了1980年至1992年1月在梅奥诊所接受嗜铬细胞瘤或副神经节瘤初次切除的110例患者的总体治疗情况及结果。
查阅患者记录，了解人口统计学信息、相关疾病、症状、实验室评估、定位技术、术前肾上腺素能阻滞剂使用情况、术中血流动力学、肿瘤位置、病理情况及结果。
最突出的症状包括头痛、出汗和心悸。47%的患者患有持续性高血压，72%的患者有典型的阵发性发作。尿甲氧基肾上腺素和香草扁桃酸联合检测该病的敏感性为98%。计算机断层扫描对肿瘤定位的阳性和阴性预测值分别为95%和100%。采用常规的α和β阻滞剂，术中高血压无相关并发症。围手术期死亡率低于1%，发病率为16%。超过90%的患者恢复到血压正常状态；其中只有20%需要药物治疗。
经腹手术切除这些肿瘤可以安全完成，住院时间通常延长一周。如今，诊断、定位、术前阻滞剂使用、术中血流动力学控制及术后管理已达到足以允许采用后路或腹腔镜手术的水平，但前提是必须在技术上能够掌握。
