褐色細胞腫の臨床的検討 : 血圧コントロールを中心に

Abstract

褐色細胞腫の17例18手術について臨床的検討を加えた. 1)術前5日間の収縮期圧の最高値は腫瘍剥離中の血圧変動幅と有意な正の相関を示した. 2)降圧剤投与下では発作併発持続型, 持続型, 発作型の順に血圧コントロールが不良であった. 3)無症候性褐色細胞腫の原因の一つに本態性低血圧が基礎にある場合があると考えられた

Surgical treatment of 18 tumors in 17 patients with pheochromocytoma, containing unsynchronous bilateral adrenal tumors, was performed at our department between 1978 and 1995. As an index of management of hypertension before and after surgery, maximum systolic blood pressure except critical region (more than mean + 2 SD) was used in this study. As an index of control of blood pressure during surgery, the difference between maximum and minimum systolic blood pressure during palpating tumor was also adopted. The index before surgery was closely correlated with the index in surgery (R = 0.646, P = 0.0038); maximum systolic blood pressure before surgery was a useful index forecasting the variation of blood pressure in surgery. The management of blood pressure before surgery was the most difficult in the group with sustained hypertension with superimposed paroxysms. After surgery, 2 patients without hypertension before surgery had hypotension, 2 others remained hypertensive and the others had normal blood pressure. Our findings indicated that the index of management of hypertension before surgery used in this study was a simple, noninvasive and important marker for variation of blood pressure in surgery.