摘要
目的 研究含嗜铬细胞瘤的多发性内分泌腺瘤(MEN)的临床特征及围术期麻醉管理。方法 回顾性总结我院1977年4月至2001年4月收治的含嗜铬细胞瘤的MEN病例。收集并分析病人一般资料、临床表现、家族史、生化检查、MEN类型、外科手术的次序、麻醉方法以及术中血液动力学变化情况。结果 共收集研究12例含嗜铬细胞瘤的MEN病例。这12例病人占同期住院治疗嗜铬细胞瘤病例的5.6％(12/213)。其中9例病人表现为MEN Ⅱa型(Sipple综合征),3例为MEN混合型。在MEN Ⅱa型中4例病人有家族史。有5例同时合并有其它内分泌疾病的嗜铬细胞瘤病人第一次手术为嗜铬细胞瘤切除术,其中仅有2例人院主诉为高血压症状。7例没有高血压症状的MEN病人第二次手术为嗜铬细胞瘤切除术。8例嗜铬细胞瘤切除术在全身麻醉下进行,4例在硬膜外麻醉下进行。有8例接受嗜铬细胞瘤切除术的病人在切除嗜铬细胞瘤前后,血液动力学波动明显。无围术期死亡病例。结论 在MEN病人中,嗜铬细胞瘤可能以主要临床表现与其它内分泌疾病相关,但更多的情况下是以无症状肿瘤的形式与其它内分泌疾病共存。认识到这一特性,对于提高嗜铬细胞瘤及MEN病人的诊疗水平具有重要的意义。
Objective To investigate the clinical features of multiple endocrine neoplasia ( MEN) associated with pheochromocytoma and anesthetic management during perioperative period. Methods Medical records of 12 patients who were operated upon for MEN associated with pheochromocytoma in our hospital from April 1977 to April 2001 were reviewed retrospectively. The demographic data, clinical manifestation, family history, biochemical examinations, type of MEN, the order of different surgical procedures for patients who had multiple operations and changes in hemodynamics were collected and analyzed. Results The 12 patients accounted for 5.6% (12/213) of the patients with pheochromocytoma admitted in the same period. Nine of the 12 patients had a diagnosis of MEN Ⅱa (Sipple syndrome) and three mixed MEN. Four patients with MEN type II a had a positive familial history. Five patients with other coexistent endocrine disorders underwent the excision of pheochromocytoma first, and only two of them had hypertensive symptoms when they were admitted. Seven patients without a history of hypertensive episodes received surgical treatment for pheochromocytoma as a second operation. The excision of pheochromocytoma was performed under general anesthesia ( in 8 patients ) or epidural anesthesia (in 4 patients). Marked hemodynamic fluctuations were recorded in 8 patients. There was no death.Conclusion Pheochromocytoma associated with other endocrine disorders in MEN may manifest itself as the main clinical symptom or most frequently as an occult tumor. Recognition of this feature is of importance to the improvement of diagnosis and treatment of both pheochromocytoma and MEN.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2003年第2期101-104,共4页
Chinese Journal of Anesthesiology
