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目的提高pheo围手术期的诊疗水平。方法52例pheo患者采用24h尿CA和血MNs进行定性诊断;对28例肿瘤直径>5cm的患者术前行3DDCE MRA或CTA检查;所有患者术前采用选择性α1受体阻滞剂多沙唑嗪控释片(可多华)控制血压;30例患者术中采用联合AHH和术中自体血回输纠正血容量。结果24h尿CA和血MNs对pheo诊断的阳性率分别为86.5%和98.1%;3DDCE MRA和CTA可清晰显示肿瘤与周围脏器、血管的关系和肿瘤主要供应血管;可多华对阵发性高血压患者的疗效满意;AHH联合术中自体血回输使23例患者避免了异体输血。结论血MNs对pheo的诊断价值优于24h尿CA;根据3DDCE MRA或CTA的检查结果选择手术径路可增加手术安全性;可多华可减少药物不良反应,疗效满意,但对持续性高血压患者,尚需联合用药,才能较好控制血压;AHH联合术中自体血回输可减少异体输血及由此而产生的并发症。
Objective To improve the perioperative diagnosis and treatment of pheo. Methods Twenty-two patients with pheo were diagnosed by 24-hour urinary CA and blood MNs qualitatively. 3DDCE MRA or CTA was performed in 28 patients with tumor diameter> 5cm. All patients were treated with selective α1-adrenergic receptor dopamine Triazine controlled release tablets (can be more China) to control blood pressure; 30 patients with intraoperative use of combined AHH and intraoperative autologous blood transfusion to correct blood volume. Results The positive rates of 24 h urinary CA and blood MNs for diagnosing pheo were 86.5% and 98.1% respectively. 3DDCE MRA and CTA could clearly show the relationship between the tumor and the surrounding organs and blood vessels and the main tumor supplying blood vessels. Blood pressure in patients with satisfactory results; AHH intraoperative autologous blood transfusion in 23 patients to avoid allogeneic blood transfusion. Conclusion The diagnostic value of blood MNs to pheo is better than that of 24h urinary CA. Choosing surgical approach according to the results of 3DDCE MRA or CTA can increase the safety of surgery. Coptisine can reduce adverse drug reactions with satisfactory curative effect. However, in patients with persistent hypertension , Still need combination therapy in order to better control blood pressure; AHH combined intraoperative autologous blood transfusion can reduce allogeneic blood transfusion and the resulting complications.