医学毕业论文肾上腺外嗜铬细胞瘤的诊断及治疗

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1、XX大学毕业论文肾上腺外嗜鎔细胞瘤的诊断及治疗姓名：2014年6月25日肾上腺外嗜铅细胞瘤的诊断及治疗作者：赵振蒙肖龙马鸿钧郝丽娜马超龙李颍崔亚菲【摘要】目的提高肾上腺外嗜钻细胞瘤的诊断和治疗水平。方法分析1986年至2005年资料完整、经病理证实的肾上腺外嗜锯细胞瘤48例。其屮高血压43例、血尿6例，体检发现肿瘤3例。48例患者中尿VMA及血、尿儿茶酚胺升高分别为44例(91%)和40例(83%)o所冇患者经B超检查，阳性率为92%、经CT扫描阳性率为100%o48例患者均行手术治疗。结杲切除肿瘤40例，包膜下剜除肿瘤8例。手术切除瘤体直径2-9cmo随访6个月・19年，43

2、例高血压患者术后血压正常31例、仍有高血压2例。肿瘤复发、转移6例，恶性嗜銘细胞瘤12例，死亡7例。结论尿VMA及血、尿儿茶酚胺是定性诊断异位嗜銘细胞瘤的主耍依据，CT诊断定位准确，131碘间位碘代茉弧(1311MIBG)定位准确、墩感性高，且可作为治疗措施。术前降压、扩容、纠正心律失常是手术成功的关键，经腹径路手术暴露良好，肿瘤外侵时可作囊内剜除，术后应密切随访。【关键词】嗜鎔细胞瘤肾上腺外诊断治疗Diagnosisandtreatmentofextraadrenalpheochromocytoma(reportof48cases)ABSTRACT:ObjectiveTohi

3、ghlightthediagnosticandtherapeuticproceduresforextraadrenalpheochromocytoma.Methods48casesofextraadrenalpheochromocytomaprovenpathologicallyfrom1986to2005werereviewedandstudied.Hypertensionwasobservedin43casesandintermittentmacrohematuriain6.3caseswereadmittedtohospitalbecauseofabdomenmasses

4、detectedthroughroutinephysicalexamination.ThelevelofurineVMAelevatedin44cases(91%)andsenimorurinarycatecholamineelevatedin40(83%).AllcaseshadBmodelultrasoundexaminationandCTsean.ThepositiveratesoflocalizationofBultrasoundandCTwere92%and100%,respectively.Allcaseshadbeentreatedwithoperation.Re

5、sultsAmongthe40caseswiththetumorincised,thespecimenswere2to9cminsize.Among40caseswithhypertension,thebloodpressureof31patientsreturnedtonormaland2caseswerestillhypertensive.12caseswereassayedasmalignantpheochromocytoma.Therewere6casesofrecurrenceormetastasesand7patientsdiedduring6monthsto19y

6、earsoffollowedup.ConclusionUrineVMAlevelisausefulmarkertodetectextraadrenalpheochromocytomaandCTscanisthemostreliableinlocalizingthelesions.1311MIBGscintigraphyisofgreatvalueforthelocalizationandquantitativeforextrarenalpheochromocytomawithhighsensitivityandaccuracy.Itmayalsobeusedasatherape

7、uticmethod.Surgicalmanipulationofthetumoristhebestmanagementandmeticulousperioperativemanagementisextremelyimportant.Measuringthelevelofurinarycatecholaminecanmonitortherecurrenceormetastasisofthetumo匸KEYWORDS:pheochromocytoma;extraadrenal;diagnosi