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Year 2015 Vol. 23 No 5
GENERAL & SPECIAL SURGERY
Î.N. SADRIEV 1, À.D. GAIBOV 1,2
COMPLEX DIAGNOSTICS AND CURRENT PRINCIPLES OF PHEOCHROMOCYTOMA TREATMENT
Republican Scientific Center of Cardiovascular Surgery1,
Avicenna Tajik State Medical University2,
The Republic of Tajikistan
Objectives. To evaluate the results of complex diagnostics and surgical treatment of patients with pheochromocytoma.
Methods. Treatment results of 25 patients with pheochromocytoma (PCC) have been analyzed (15 (60%) females and 10 (40%) males). The average age of patients was 35,9±4,2 years. Average duration on the disease was 4,6±1,7 years. Diagnosis was confirmed by ultrasonography (US), computerized tomography (CT) and determination of metanephrines (MN) and vanillylmandelic acid (VMA) levels. Depending on the preoperative tactics all patients were divided into 2 groups. Α-blockers of short-acting (phentolamine) were used to the patients of the first group (n=8) only during the operation. Α-blockers (doxazosin) were administered to the patiens of the second group (n=17) in the preoperative period.
Results. In all cases a reliable increase of MN and VMA levels was registered. No difference was found in studying MN excretion level depending on the tumor size and disease duration. Sensitivity of US and CT in PCC diagnostics made up 92% and 100%, and specificity 52% and 91,3%, respectively. In the 1st group 2 (25%) patients died due to the development of «uncontrolled hemodynamics» syndrome. There was no lethal outcome in the 2nd group (ð<0,05). Complications were observed in 5 (21,7%) patients during the operation (n=2) and in the early postoperative period (n=3). There was 1 (4,3%) lethal outcome after adrenalectomy. In the long-term period (1-8 yrs) good results were obtained in 21 (91,3%) operated patients and satisfactory – in 1 (4,3%).
Conclusion. The use of minimally invasive techniques in the treatment of pheochromocytoma can help reduce the incidence of postoperative complications and duration of hospitalization. In all cases the preoperative preparation should be carried out with the use of α-blockers. The patients are required clinical medical examination and proper conduction of hormone replacement therapy to prevent and treat adrenal insufficiency.
- Bokeriia LA, Abdulgasanov RA. Feokhromotsitomy: sovremennye metody diagnostiki i khirurgicheskogo lecheniia [Pheochromocytoma: modern methods of diagnosis and surgical treatment]. Annaly Khirurgii. 2011;(2):5-10.
- Bel'tsevich DG, Kuznetsov NS, Lysenko MA, Tsalikova AT. Feokhromotsitoma [Pheochromocytoma]. Sonsilium Medicum. 2007;9(9):88-94
- Fernández-Cruz L, Puig-Domingo M, Halperin I, Sesmilo G. Pheochromocytoma. Scand J Surg. 2004;93(4):302-9.
- Ilias I, Pacak K.A clinical overview of pheochromocytomas/paragangliomas and carcinoid tumors. Nucl Med Biol. 2008 Aug;35 Suppl 1:S27-34. doi: 10.1016/j.nucmedbio.2008.04.007.
- Bel'tsevich DG, Kuznetsov NS. Prichiny retsidivov u bol'nykh s opukholiami khromaffinnoi tkani [Causes of relapses in patients with tumors chromaffin tissue]. Khirurgiia. Zhurn im NI Pirogova. 2002;(8):19-23.
- Thompson LD. Pheochromocytoma of the adrenal gland scaled score (PASS) to separate benign from malignant neoplasms: A clinicopathologic and Immunophenotypic study of 100 cases. Am J Surg Pathol. 2002 May;26(5):551-66.
- Troshina EA, Bel'tsevich DG, Iukina MIu. Laboratornaia diagnostika feokhromotsitomy [Laboratory diagnosis of pheochromocytoma]. Probl Endokr. 2010;56(4):39-43.
- Vetshev PS, Simonenko VB, Ippolitov LI. Opukholi khromaffinnoi tkani (klinika, diagnostika, khirurgicheskoe lechenie) [Chromaffin tissue tumors (clinical features, diagnosis, surgical treatment)] Khirurgiia. Zhurn im NI Pirogova. 2002;(8):11-18.
- Mel'nichenko GA, Udovichenko OV, Shvedova AE. Endokrinologiia: tipichnye oshibki prakticheskogo vracha [Endocrinology: typical mistakes of practitioner]. Moscow, RF: Prakt Meditsina; 2011. 176 p.
- Emel'ianov SI, Kurganov IA, Oganesian SS, Bogdanov DIu. Rol' trekhmernogo virtual'nogo modelirovaniia i intraoperatsionnoi navigatsii pri laparoskopicheskikh vmeshatel'stvakh na nadpochechnikakh [The role of three-dimensional virtual simulation and intraoperative navigation in laparoscopy on the adrenal glands]. Endosk Khir. 2009;(5):41-47.
- Tsukanov IuT, Tsukanov AIu. Bokovoi vnebriushinnyi mini-dostup dlia adrenalektomii [Lateral extraperitoneal mini access for adrenalectomy]. Khirurgiia. Zhurn im NI Pirogova. 2003;(9):7-10.
- Bondarenko VO, Lutsevich OE. Topograficheskaia diagnostika i khirurgicheskie vmeshatel'stva pri gigantskikh feokhromotsitomakh nadpochechnika [Topographic diagnosis and surgery for adrenal pheochromocytoma giant]. Khirurgiia. Zhurn im NI Pirogova. 2011;(30):13-18.
- Dedov II, Bel'tsevich DG, Kuznetsov NS, Mel'nichenko G A. Feokhromotsitoma [Pheochromocytoma]. Moscow, RF: Prakt Meditsina; 2005. 216 p.
734003, Republic of Tadzhikistan,
g. Dushanbe, prospekt Rudaki, d. 139,
meditsinskiy universitet imeni Abuali ibni Sino,
kafedra khirurgicheskih bolezney ¹2.
tel.: 992 915 25 00 55;
Sadriev Okildzhon Nemadzhonovich
Sadriev O.N. A leading researcher of the Republican Scientific Center of Cardiovascular Surgery.
Gaibov A.D. Corresponding member of the Academy of Medical Sciences of the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan, MD, professor of the surgical diseases chair ¹2 of Avicenna Tajik State Medical University, professor and tutor of the vascular surgery department of the Republican Scientific Center of Cardiovascular Surgery.