褐色細胞腫38例の臨床的検討 : 術中の血圧変動と尿中VMAの関連性について

Abstract

手術を行った褐色細胞腫38症例を対象に, 術中の血圧変動を予測する因子を検討するために尿中カテコールアミン代謝産物を測定した。副腎外発生例は6例で, 全例に高血圧を認めた。そのうち, 尿中カテコールアミンを測定した5例は全てノルアドレナリン分泌優位型(NAd型)であった。術前に高血圧を33例(87%)に認め, 発作性高血圧(発作型:12例・持続発作型:9例)が21例(64%), 持続型高血圧は12例であった。アドレナリン分泌優位型(Ad型)は発作性高血圧(発作型・持続発作型)19例中10例(52.7%), NAd型は持続型高血圧・正常型15例中9例(60%)であった。術中に血圧変動がみられたのは15例で, 発作型:73%, 持続発作型:75%, 持続型:40%, 正常型:0%であった。また, 24時間蓄尿中のバニリルマンデル酸(VMA)は血圧安定群14例に比べ, 有意に高値であった。24時間蓄尿中のカテコールアミン代謝産物の測定, 術前の高血圧分類, 尿中VMA分泌量は術中の血圧変動の予測因子と考えられた。

Pheochromocytoma is a rare tumor of chromaffin tissues most commonly arising from the adrenal medulla. We retrospectively reviewed the records of 38 patients with pheochromocytoma who underwent surgical treatment between 1977 and 2004 at our Yokohama City University Medical Center and Yokohama City University Hospital. Twenty two patients (57.9%) were females and 16 (42.1%) were males. The most frequent symptoms were headache (58%). One patient had bilateral adrenal tumors and pathological examination revealed malignant pheochromocytoma. Six patients had an extra-adrenal tumor and in 2 patients the tumor occurred in the urinary bladder. Twelve patients (31.6%) had sustained hypertension, 21 patients (55.3%) had paroxysmal hypertension and 5 patients (13.1%) remained normotensive. The 24-h urinary total metanephrines and vanillylmandelic acid (VMA) were the most sensitive biochemical tests for the diagnosis of pheochromocytoma. The sensitivity of urinary total metanephrines was 92.0% for all the patients and was 92.3% for the patients without paroxysmal hypertension. Fifteen patients had intraoperative hypertensive reactions in the surgical manipulation or hypotension after tumor resection. This group had more urinary excretion of VMA before surgery, compared with that with stable intraoperative blood pressure (p < 0.005).