褐色細胞腫30例の治療経験

Abstract

男14例, 女16例で, 平均年齢は45.3歳, 発症部位は副腎21例, 副腎外9例で, 悪性褐色細胞腫を2例(7%)認めた.高血圧のタイプは発作型13例, 持続型13例であった.腫瘍の局在診断ではCTと静脈血サンプリングが有用であった.術後1週間の尿中カテコールアミン値はノルエピネフリンの正常化が遅れる傾向を示したが, 血圧は術前に高血圧を認めた症例の85%が正常化していた.平均観察期間8.1年の予後調査で, 27例中21例は治癒と判定され, 2例に高血圧が認められた.死亡例は4例で, 内訳けは血管撮影時のショック死1例, 術直後の肺水腫1例, 悪性褐色細胞腫の転移による腫瘍死2例であった

A study of 30 cases of pheochromocytoma encountered at our department between 1959 and 1986 is presented. Fourteen patients were males and 16 were females. Their ages ranged from 18 to 72 years with a peak incidence in the fifties. Hypertension was present in 87% of the patients. The incidence of extra-adrenal tumors was 30% and that of malignancy 7%. The 24-hr urinary level of catecholamine was to a certain degree in accord with the location of the tumor and type of hypertension. Computed tomography and venous sampling were very useful for the diagnosis which had an accuracy rate of 100% in this series. Preoperative management using an alpha-blocker was effective in controlling blood pressure and circulating blood volume in most cases. Postoperative blood pressure was normalized within a week after operation in 85% of the patients who had been suffering from hypertension, although elevated levels of norepinephrine in urine were still noted in 56% of the patients one week after operation. Of the 27 follow-up cases, 21 cases (78%) were in good health and 2 cases were alive with hypertension with a mean follow-up period of 8.1 years. Four patients died, one during angiography, one of pulmonary edema one day after operation and the other 2 of metastases of malignant pheochromocytoma.