嗜铬细胞瘤术前CT影像学参数与围手术期参数的相关性研究

doi:10.16150/j.1671-2870.2020.02.014

摘要/Abstract

摘要：

目的：分析嗜铬细胞瘤患者术前的CT影像学资料,评价其在嗜铬细胞瘤患者术前、术中及术后评估中的应用价值。方法：收集我院164例嗜铬细胞瘤患者术前的CT检查参数,并收集其术前血儿茶酚胺激素[包括甲氧基肾上腺素（metanephrine, MN）和甲氧基去甲肾上腺素（normetanephrine,NMN）]水平、术中失血量、麻醉用药情况及术后并发症等相关资料,分析肿瘤的CT影像学参数与MN、NMN水平间的关系,计算肿瘤部位的增强CT值与嗜铬细胞瘤体积的乘积（enhanced CT value × volume, EV）值及其与术中失血量、麻醉用药情况、术后并发症发生情况间的相关性。结果：①嗜铬细胞瘤患者的术前血NMN（P<0.001, r=0.535）、MN（P=0.001,r=0.257）水平与EV值间有一定相关性。多变量线性回归分析显示,术前血NMN（P=0.001）水平是EV值升高的独立影响因素。②患者术中麻醉使用的酚妥拉明用量（P=0.001, r=0.279）、术中失血量（P<0.001, r=0.479）与EV值呈显著正相关。当患者的EV值大于4 719.65 HU·cm³（曲线下面积为0.890）时,其术中失血量>800 mL的风险明显升高（OR=1.349）。③患者的术后并发症发生情况与其EV值间呈显著正相关（P<0.001, r=0.317）,当EV大于15 610.62 HU·cm³（曲线下面积为0.799）时,患者术后发生大于Ⅱ级并发症的风险明显升高（OR=1.640）。结论：嗜铬细胞瘤患者术前CT影像学参数（EV值）与其术前血儿茶酚胺激素水平、术中失血量及麻醉使用的酚妥拉明总量、术后并发症发生情况显著相关,可为患者进行充分术前准备、术中麻醉风险估计、术后并发症预估提供重要的参考依据。

关键词: 嗜铬细胞瘤, 计算机体层成像, 评估, 并发症

Abstract:

Objective: To explore the value of pre-operative CT scanning for preoperative, intraoperative, and postope-rative evaluation of patients with pheochromocytoma. Methods: A total of 164 patients with pheochromocytoma were enrolled from January 2014 through April 2019. Correlation of pre-operative CT imaging parameters product of enhanced CT value in the lesion and tumor size (EV) with levels of preoperative metanephrine (MN) and normetanephrine (NMN), loss of intraoperative blood, postoperative complications were analyzed. Results: Both pre-operative NMN and MN were positively correlated with EV (P<0.001, P=0.001). Multivariate analysis showed that NMN was an independent factor for increment of EV(P=0.001). EV had a significant positive correlation with intraoperative dosage of phentolamine (P<0.001) and blood loss (P<0.001). Receiver operator characteristic (ROC) curve analysis showed that when EV was greater than 4 719.65 HU·cm³ (P<0.001, AUC=0.890), the risk of major intraoperative blood, defined as loss >800 mL, increased significantly. EV was positively correlated with incidence of postoperative complications (P<0.001). When EV was greater than 15 610.62 HU·cm³ (P<0.001, AUC=0.799), the risk of postoperative complications >Ⅱ significantly increased. Conclusions: CT-based imaging parameter EV is highly correlated with intraoperative phentolamine dosage, incidence of postoperative complications and levels of pre-operative NM, NMN. Pre-operative CT scanning might provide important information for preoperative preparation, intraoperative anesthesia and prevention of postoperative complications in the manangement of pheochromocytoma.

Key words: Pheochromocytoma, Computer-tomography, Evaluation, Complications

中图分类号:

R586.9

马文明, 李强, 卓然, 冒永鑫, 戴军, 罗艳, 孙福康. 嗜铬细胞瘤术前CT影像学参数与围手术期参数的相关性研究[J]. 诊断学理论与实践, 2020, 19(02): 172-176.

MA Wenming, LI Qiang, ZHUO Ran, MAO Yongxin, DAI Jun, LUO Yan, SUN Fukang. The pre-operative CT parameters and perioperative manangement of pheochromocytoma[J]. Journal of Diagnostics Concepts & Practice, 2020, 19(02): 172-176.

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项目	数值
性别（男/女）	71/93
诊断年龄（岁）	44（34~57）
高血压（n）	87
增强CT值(HU）	85.05（64.63~104.08）
肿瘤体积（cm³）	33.42（14.55~69.46）
MN（pg/mL）	76.05（62.45~153.43）
NMN（pg/mL）	546.10（179.73~1 833.15）
失血量（mL）	100（50~275）
酚妥拉明用量（mg）	1.70（0.02~6.51）
术后并发症分级>Ⅱ级（n）	14

项目	EV值
项目	B	Std	Beta	t值	P值
性别（女）	-0.008	0.017	-0.035	-0.480	0.632
年龄	-0.004	0.003	-0.102	-1.368	0.173
MN	0.073	0.034	0.153	2.148	0.502
NMN	0.100	0.017	0.430	5.978	0.001

变量	酚妥拉明>1.7 mg		失血量>800 mL		术后并发症>Ⅱ级
变量	比数比（95%置信区间）	P值	比数比（95%置信区间）	P值	比数比（95%置信区间）	P值
性别（女）	1.118(0.841~1.486)	0.444	0.483(0.092~2.550)	0.392	0.936(0.668~1.311)	0.699
年龄	0.991(0.967~1.016)	0.485	1.003(0.949~1.060)	0.922	0.974(0.922~1.030)	0.357
高血压	1.690(0.842~3.393)	0.140	0.869(0.167~4.516)	0.867	1.015(0.202~5.103)	0.985
EV值	1.166(0.957~1.419)	0.127	1.349(1.076~1.690)	0.009	1.640(1.233~2.181)	0.001
术式
机器人	0.856(0.179~4.102)	0.846	0.900(0.103~7.897)	0.924	4.294(0.747~24.700)	0.103
腹腔镜	1.077(0.541~2.143)	0.833	0.235(0.025~2.214)	0.206	0.498(0.072~3.457)	0.482