| Objective To explore the clinical value of plasma free metanephrine and normetanephrine in patients with pheochromocytoma/paragangliomas.Methods The clinical data of 62 patients,who were pathologically diagnosed as pheochromocytoma/paragangliomas and underwent examination of plasma free metanephrines in our hospital from September,2012 to October,2017,was retrospectively analysed.Corelation analysis between metanephrines and other clinical factors was conducted by SPSS software.Results There was a significant positive corelationship between tumor size and plasma free MN and NMN(rho=0.462 P=0.000;rho=0.463 P=0.000,respectively).There was a slight positive correlationship between plasma free NMN and plain CT scan value(rho=0.368,P=0.025)and enhanced CT scan value(rho=0.339,P=0.040).The result showed a statistical difference in plasma free MN between patients with and without typical symptoms of hypercatecholemia(P=0.002),but no difference was found in plasma free NMN.Under adequate preoperational preparation,plasma free NMN was higher in patients with a hemodynamic fluctuation during surgery than those without fluctuation.The difference shows statistical significance.Plasma free MN and NMN was significantly decreased after surgery in 15 patients(P=0.036?P=0.004 respectively).No corelation were observed between MNs and sex,age,tumor location.Conclusion Patients with typical symptoms?CT manifestations and larger tumors often present a higher level of MNs.Patients with higher level of blood NMN tends to suffer a drastic hemodynamic fluctuation perioperationally.MNs can be a reliable biomarker to evaluate the effect of surgery.Examination of MNs provide significant clinical value in diagnosis and treatment of pheochromocytoma/paragangliomas.Objective To analyze the main causes for unplanned re-operation of pheochromocytoma(Pheo)and explore the countermeasures on reducing the re-operation rate.Methods The clinical data of 6 patients with pheochromocytoma who underwent an unplanned re-operation were analyzed retrospectively between September 2011 and December 2016 in the First Affiliated Hospital of CQMU.There were 4 males and 2 females with a mean age of 46 years,ranged from 24 to 60 years.Only 1 patient had paroxysmal hypertension and headache,other 5 patients had no or atypical symptoms.3 cases were located in adrenal gland,and 3 were extra-adrenal Pheos.The average size of tumor were 5.25cm,ranged from 3 to 10cm.Among the 6 cases,2 cases were diagnosed as Pheo preoperatively and given adequate preparation,achieved stable hemodynamics during the first operation,yet encountered with post-operative bleeding soon after the surgery.4 cases were misdiagnosed,following poor preoperative preparation caused abortion of operation,1 case were misdiagnosed as bladder carcinoma and underwent transurethral resection.Results The unplanned re-operation rate is 6.12%(6/98).All 6 re-operations were performed by Urology Department.The main cause for unplanned re-operation are as follows:perioperative hemodynamic fluctuation(50%),post-operative bleeding(33.3%),uncertainty of surgical effect(16.7%).Conclusion A precise diagnosis and an adequate preoperative preparation are the key to prevent a second-look surgery;an appropriate surgical approach and a complete surgical hemostasis will help lowering the rate of re-operation... |
PDF Full Text Request