| Objective:Retrospective analysis of43patients with pheochromocytoma from December2009to May2013at the affiliated provincial hospital of Shangdong University. The clinical manifestations, diagnosis, auxiliary examination, operation treatment, immunohistochemistry, and follow-up were analyzed to provide a reliable basis for the clinical diagnosis and treatment.Methords:This paper reviewed43patients with pheochromocytoma from December2009to May2013at the affiliated provincial hospital of Shangdong University.23patients were male (53.49%) and20patients were female (46.51%), they were from11to76years’old (46.51±2.32). The history of hypertension was from one month to22years, the tumor diameter was5.34±2.60cm, in43patients,18(41.86%) cases were left adrenal pheochromocytoma,12(27.91%) cases were right adrenal pheochromocytoma,6(13.95%) cases were bilateral,7(16.28%) cases were ectopic. All patients had successful operation, preoperative preparation time was9.40±5.33days, including13cases of open group (30.23%),30cases of laparoscopic group (69.77%); operation time:the open group was3.38±1.92hours, laparoscopic group was3.01±3.43hours; Intra-operative blood loss:the open group was796.15±576.05ml, laparoscopic group was196±212.56ml;The average hospitalized number of days were21.13±7.89days (10～43days). The statistical analysis was proceeded in clinical manifestations, diagnosis, auxiliary examination, operation treatment, immunohistochemistry and follow-up. Results:1The most common clinical manifestations of pheochromocytoma was hypertension, which was about95.35%of total. Headache, excessive sweating and palpitation were pheochromocytoma’s special performance. In43patients,12(27.91%) cases had only one of these three clinical manifestations,25(58.14%) cases had two kinds of these three clinical manifestations,4(9.30%) cases simultaneously had all kinds of these three clinical manifestations, those2cases (4.65%) who had no clinical manifestation were all new cases found in physical examination. In43patients,18(41.86%) cases were left adrenal pheochromocytoma,12(27.91%) cases were right adrenal pheochromocytoma,6(13.95%) cases were bilateral,7(16.28%) cases were ectopic pheochromocytoma.2In43patients,9were examed with the urine VMA,5were positive and the positive rate was55.56%.26cases of CT examination revealed the tumor diameter was5.00±1.97cm,15cases of magnetic resonance imaging (MRI) examination revealed the tumor diameter was5.35±2.72cm, there were no significant differences between CT examination and MRI examination of tumor diameter and pathological diameter (P>0.05).3Preoperative preparation:All patients underwent preoperative expansion of blood volume and antihypertensive therapy, Compound Dextran40Injection (500ml ivdrip qd) was used for intravascular volume-expansion. α-receptor blocker Phenoxy-benzamine (from15-30mg po. tid to30-60mg po. tid) was used for blood-pressure-lowering. The pre-operative time was from2days to20days (8.86±4.49). The length of time of both intravascular volume expansion and α-receptor blocker had no influence on blood pressure fluctations during operation (P>0.05).4In27patients whose tumor diameter<6cm,22cases (81.48%) experienced laparoscopic operation,5cases(18.52%) experienced open operation. In these5open operation cases,2were ectopic pheochromocytoma and1were bilateral pheochromocytoma. In16patients whose tumor diameterr≥6cm,8cases experienced open operation (50%) and8cases experienced laparoscopic operation whose tumor diameter was from6to7.5cm.5Patients with laparoscopic operation were significantly lower than patients with open operation in operation time, bleeding volume, the amount of RBC, postoperative drainage and drainage time (P<0.05).6Immunohistochemistry:In7patients with ectopic pheochromocytoma,6patients were exzamied with the CgA, Syn, S-100and Ki-67. The negative rate of CgA was100%, the positive rate of Syn was100%, the positive rate of S-100was83.33%.15patients’s value of Ki-67was more than1, and they all had malignant tendency. The only one case whose S-100was negative, Ki-67was more than1.7Follow up:Postoperative follow-up was succeeded in42patients. In24patients with hypertention,12(50%) patients’blood pressure returned to normal. In23patients with blood glucose abnormalities,14(60.87%) patients’blood glucose returned to normal,42patients’cortisol, angiotensin, aldosterone, angiotensin II, and VMA were normal.Conclusions:1Hypertension was the major clinical manifestations of pheochromocytoma patients, the onset of hypertension compared with other secondary hypertension disease had no specificity. For the merger of headache, sweating, palpitation and other symptoms of malignant hypertension patients, we should be alert to exclude pheochromocytoma.2Urinary VMA has certain value in the diagnosis of pheochromocytoma, but the positive rate was low. CT and MRI had important value for diagnosis of pheochromocytoma, especially pheochromocytoma in MRI had specificity high signal on the T2-weighted images, it had great significance on preoperative diagnosis of the tumor nature.3Sufficient pre-operative preparation can make patients perioperative blood pressure stable, and ensure the operation safety. But the time of using preoperative intravascular volume expansion and α-receptor blocker had no significant influence on blood pressure4The adrenal pheochromocytoma tumor diameter<6cm was the indication of laparoscopic operation. For the cases whose pheochromocytoma tumor diameter≥6cm need make operation plan according to the tumor location, size and properties.5Patients with laparoscopic operation were significantly lower than patients with open operation in operation time, bleeding volume, the amount of RBC, postoperative drainage and drainage time.6The CgA was all not expressed in ectopic pheochromocytoma. In the patients whose Ki-67>1, some patients’S-100was negative, and these patients showed no malignancy in the postoperative follow-up.7Postoperative follow-up showed that the operation was effective in the treatment of pheochromocytoma. |
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