论文部分内容阅读
患者,女,47a。右侧腰、腹部疼痛15d,间歇性高血压发作1a。入院前血压为18～24/10.6～12kPa,B超发现右肾上腺肿瘤,大小为39mm×46mm×51mm,呈稍强光团,周围见包膜,边界清。CT提示右肾上腺肿瘤。尿中香草扁桃酸(VMA)24h排出量检查6次,其值均明显升高,在10.7～19.0mg/24h尿量之间。患者左肾上腺及其它内分泌器官未发现异常,否认内分泌腺瘤形成的家族史。体检未发现异常的肿块。初步诊断:右肾上腺嗜铬细胞瘤。 1997年1月22日在连续硬膜外麻醉下经腹行右肾上腺肿瘤切除术。术中见肿瘤有包膜,与下腔静脉、肾动静脉紧密粘连,经仔细分离,肿瘤被完整切除。手术过程中患者血压曾有波动,但不明显。切除肿瘤标本巨检:暗红色球状组
Patient, female, 47a. The right side of the waist, abdominal pain 15d, intermittent hypertension attack 1a. Pre-hospitalization blood pressure was 18 to 24/10.6 to 12 kPa. B-ultrasonography found a right adrenal tumor with a size of 39 mm x 46 mm x 51 mm. It was a slightly lighter mass with surrounding capsules and clear borders. CT suggests a right adrenal tumor. The urinary vanilla-mandelic acid (VMA) output of 24 h was examined 6 times, and their values were significantly increased, ranging from 10.7 to 19.0 mg/24 h urine volume. No abnormalities were found in the left adrenal gland and other endocrine organs, and the family history of endocrine neoplasia was denied. Physical examination revealed no abnormal mass. Initial diagnosis: Right adrenal pheochromocytoma. On January 22, 1997, right adrenal tumors were resectioned under continuous epidural anesthesia. During the operation, the tumor was enveloped and closely adhered to the inferior vena cava and renal arteriovenous. After careful separation, the tumor was completely resected. The patient’s blood pressure fluctuates during the operation, but it is not obvious. Excision tumor specimen examination: dark red spherical group