2023 年第 9 期 第 18 卷

囊性肾上腺嗜铬细胞瘤围手术期管理1例报道

Perioperative management of cystic adrenal pheochromocytoma: a case report

作者：徐薇1杨恋恋2罗俊1

英文作者：Xu Wei1 Yang Lianlian2 Luo Jun1

单位：1四川大学华西医院麻醉科，成都615000；2四川大学华西医院肿瘤科，成都615000

英文单位：1Department of Anesthesiology West China Hospital Sichuan University Chengdu 615000 China; 2Department of Oncology West China Hospital Sichuan University Chengdu 615000 China

关键词：嗜铬细胞瘤；全身麻醉；酚妥拉明；围手术期

英文关键词：Pheochromocytoma;Generalanesthesia;Phentolamine;Perioperativeperiod

• 摘要：

• 嗜铬细胞瘤（PHEO）是一种罕见的神经内分泌肿瘤，而囊性PHEO是一种更为罕见的特殊类型，由于囊性PHEO产生的儿茶酚胺及其代谢物被囊袋包裹导致围手术期容易发生血流动力学剧烈波动，可以通过充分的术前准备、精准的危险预判和最佳的控压方案达到个体化的麻醉管理，维持麻醉期间循环系统的稳定。本文报道1例54岁男性囊性肾上腺PHEO患者，经过1个月的术前准备，围手术期在全身麻醉诱导后、体位改变时及切除肿瘤时仍发生血流动力学剧烈且规律波动，单用间羟胺、艾司洛尔、硝普钠等效果不佳，联合酚妥拉明、乌拉地尔、去甲肾上腺素等药物后切除肿瘤，术后恢复良好。

• Pheochromocytoma (PHEO) is a rare neuroendocrine tumor, while cystic PHEO is an even rarer special type. Due to the fact that catecholamine and its metabolites produced by cystic PHEO are enveloped by the cyst, there is a high risk of significant hemodynamic fluctuations during the perioperative period. Individualized anesthesia management can be achieved through adequate preoperative preparation, accurate risk prediction and the best pressure control scheme to maintain the stability of the circulatory system during anesthesia period. This article reports a 54-year-old male patient with cystic adrenal PHEO. After 1 month of preoperative preparation, the patient still experienced severe and regular hemodynamic fluctuations after induction of general anesthesia, during body position change and during tumor resection. The mono-use of hydroxylamine, esmolol, sodium nitroprusside and other drugs has poor efficacy. The tumor is removed after combined with phentolamine, urapidil, norepinephrine and other drugs, and the postoperative recovery is good.