The pre-operative CT parameters and perioperative manangement of pheochromocytoma

doi:10.16150/j.1671-2870.2020.02.014

Abstract

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

CLC Number:

R586.9

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.

Figures/Tables 5

References 21

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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	P值	r值
MN	0.001	0.257
NMN	<0.001	0.535
失血量	<0.001	0.479
酚妥拉明用量	0.001	0.279
术后并发症分级	<0.001	0.317

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