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中華民國泌尿科醫學會雜誌

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篇名 Pheochromocytoma in Pregnancy: Two Cases Report and Literature Review
卷期 8:3
並列篇名 懷孕合併嗜鉻細胞瘤之二病例報告以及文獻回顧
作者 查岱龍謝啟誠陳安馬正平張聖原于大雄
頁次 162-167
關鍵字 嗜鉻細胞瘤懷孕兒茶酚氨pheochromocytomapergnancycatecholamineTSCI
出刊日期 199709

中文摘要

懷孕婦女合併咾鉻細胞瘤在臨床上較少見,但常引起診斷上的困難而導至孕婦及胎兒的不良結果。本院有兩位病人於懷孕期間因持續性高血壓、心悸、頭痛、及不適感等臨床症狀而接受檢查,尿液及血清生化檢查確定嗜鉻細胞瘤此一診斷,並利用超音波及核碰共振作腫瘤定位。一孕婦於第二衽娠期,另一孕婦於懷孕末期接受單側腎上腺腫瘤切除術;術後母親及一足月嬰兒情況良好,另一胎兒則死亡。雖然懷孕中合併嗜鉻細胞瘤常造成診幽及治療上許多的問題,但憑藉高度的警覺心及有效的生化檢查,依然可達到早期診斷的效果,而利用超音波及核碰共振作腫瘤定位對胎兒是十分安全的檢查,手術前使用腎上腺激素阻斷劑可對血壓作良好的控制。治療上,於第一衽娠期,人工流產之後再將腫瘤切除為適當的選擇,第二衽娠期時,則切除腫瘤並保留胎兒,而第三衽娠期時,則行剖腹生產並同時切除腫瘤。總而言之,懷孕婦女合併咾鉻細胞瘤此一疾病的控制,孕婦和胎兒的監測,及手術時間的選擇,必須在一團隊包括產斗、內科、小兒科、麻醉科及外科醫師的共同努力下方能完成。

英文摘要

A pheochomocytoma n pregnancy is a rare event which raises specific diagnostic difficult-ties and bears poor maternal and fetal prognosis. We report two cases of pregnancy with pheo-chromocytoma. They were diagnosed due to a variety of the clinical pictures such as persistent hypertension, palpitation, headache and diaphoresis. Urine and serum examinations for catecho-lamine level and corticotropic hormones were consistent with the diagnosis. The tumors were lo-calized by ultrasound and magnetic resonance image (MRI). Unilateral adrenalectomy was per-formed in the second trimester for one of the omthers and postpartumly in the other. No complic-cations were noted for either mother. The full-term fetus was well postoperatively, but intrauter-ine fetal death occurred in the other two weeks after adrenalectomy. Although pregnancy with a pheochomocytoma poses a complex problem for diagnosis and management, an early diagnosis can still be done under a high level of suspicion and with the support of effective biochemistry studies. Localization by ultrasound and MRI is safe for the fetus. Preoperative management with adrenergic blockades is well tolerated in the control of blood pressure. In the first trimester, abortion and removal of tumor is an appropriate option, and in the second trimester, excision of tumor and preservation of the fetus is a reasonable alternative choice. Every effort should be made to save a normal fetus if the tumor is first discovered during the third trimester. Regardless. Appropriate control of disease, careful surveillance of mother and fetus, and optimal timing for surgery should be attributed to a teamworkwhich includes gynecologist, internist, pediatrician, anesthetist and urologist. (J Urol R.O.C., 8:162-167,1997)

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