[The discussion of standards for clinical functional gradation and preoperative preparation of pheochromocytoma].
OBJECTIVE
To discuss the standards for clinical functional gradation and preoperative preparation of pheochromocytoma.


METHODS
According to the preoperative clinical manifestations and 24 hr urine catecholamine, 172 cases of pheochromocytomas were divided into 4 grades. Functionary grade 0 including 22 patients was given no volume expansion. Functionary Grade 1 consisted of 17 cases, 10 of which were given phenoxybenzamine orally 5 - 10 mg/d for 1 week (therapeutic group), the rest were control group; the results were analyzed by the chi(2) test. Functionary Grade 2 including 120 patients had phenoxybenzamine orally 30 - 240 mg/d for 4 weeks, hemodynamics and microcirculation image were standards for evaluating volume expansion. Functionary Grade 3 consisted of 13 patients including 1 with acute heart failure, 2 and 10 patients with past history of cerebral hemorrhage and hypertensive crisis respectively, they were treated with enough phenoxybenzamine and other emergent measures.


RESULTS
The perioperative blood pressure of Functionary Grade 0 had no fluctuation. The blood pressure of therapeutic group of Functionary Grade 1 had small range fluctuation (< 20 mm Hg), that of the control group was large (> 40 mm Hg). Chi(2) = 13.12, P < 0.01. The hemodynamics of Functionary Grade 2 and Grade 3 recovered within 24 hours postoperatively and no complications occurred.


CONCLUSIONS
According to the function of pheochromocytoma, it is safe and efficient to use different preoperative preparations. Hemodynamics and microcirculation image are golden standards for evaluating preoperative preparations.
Pan
Dong-liang
DL
Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China.
Li
Han-zhong
HZ
Zeng
Zheng-pei
ZP
D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D001794:Blood Pressure; D004298:Dopamine / Q000097:blood; D004837:Epinephrine / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative; D009638:Norepinephrine / Q000097:blood; D010643:Phenoxybenzamine / Q000627:therapeutic use; D010673:Pheochromocytoma / Q000175:diagnosis* / Q000601:surgery; D011292:Premedication; D011300:Preoperative Care / Q000592:standards*; D014665:Vasodilator Agents / Q000627:therapeutic use
D014665:Vasodilator Agents; D010643:Phenoxybenzamine; D004298:Dopamine; D009638:Norepinephrine; D004837:Epinephrine