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目的探讨膀胱嗜铬细胞瘤的诊断和治疗经验。方法回顾性分析本院2003年4月至2010年4月诊治的7例膀胱嗜铬细胞瘤患者的临床资料。男性3例,女性4例,平均年龄45.3(31~57)岁。高血压者6例,5例在排尿时血压明显增高;间歇性肉眼血尿者3例。血浆游离MNs和24h尿CA定性诊断的阳性率分别为100.0%(7/7)和85.7%(6/7)。定位检查包括B超、CT、MRI、131I-MIBG和膀胱镜,其各自的定位准确率分别为85.7%(6/7)、100.0%(6/6)、66.7%(2/3)、100.0%(5/5)和75.0%(3/4)。1例进行放射治疗,2例实施膀胱部分切除,4例进行肿瘤剜除。结果 7例膀胱嗜铬细胞瘤在膀胱内的位置为:前壁2例、三角区2例、后壁1例、左侧壁1例、右侧壁1例。平均手术时间131.2(110~190)min,平均出血量283(100~1 200)mL。良性者6例,恶性者1例。随访5个月~7年,1例于术后3年复发,2次手术行全膀胱切除术。结论膀胱嗜铬细胞瘤罕见且容易误诊,高血压、血尿、排尿时典型发作为其主要症状;血浆游离MNs和24h尿CA是重要的定性检查方法,B超、CT、MRI、131I-MIBG及膀胱镜是重要的定位诊断方法;膀胱部分切除或肿瘤剜除是首选的治疗方法,术后应长期随访。
Objective To investigate the diagnosis and treatment of bladder pheochromocytoma. Methods The clinical data of 7 cases of bladder pheochromocytoma treated in our hospital from April 2003 to April 2010 were retrospectively analyzed. There were 3 males and 4 females with an average age of 45.3 (31-57 years). Hypertension in 6 cases, 5 cases of urinary hypertension was significantly increased; intermittent gross hematuria in 3 cases. The positive rates of qualitative diagnosis of plasma free MNs and 24 h urine CA were 100.0% (7/7) and 85.7% (6/7), respectively. The accuracy of localization was 85.7% (6/7), 100.0% (6/6), 66.7% (2/3), 100.0 % (5/5) and 75.0% (3/4). One patient underwent radiotherapy, two patients underwent partial excision of the bladder, and four patients underwent tumor excision. Results The location of bladder pheochromocytoma in 7 cases was: anterior wall in 2 cases, triangle in 2 cases, posterior wall in 1 case, left wall in 1 case and right wall in 1 case. The average operation time was 131.2 (110-190) min and the average amount of bleeding was 283 (100-1 200) mL. 6 cases of benign, 1 case of malignant. Followed up for 5 months to 7 years, 1 case of recurrence 3 years after surgery, 2 times underwent total cystectomy. Conclusions Bladder pheochromocytoma is rare and easily misdiagnosed, with typical episodes of hypertension, hematuria and urination as its main symptoms. Plasma free MNs and 24-hour urine CA are important qualitative examination methods. B-ultrasound, CT, MRI, 131I-MIBG and Cystoscopy is an important diagnostic method of positioning; partial resection of the bladder or tumor removal is the preferred method of treatment, after surgery should be long-term follow-up.