子宫-膀胱间隙异位副神经节瘤诊治一例

doi:10.12280/gjszjk.20240487

摘要/Abstract

摘要：

副神经节瘤（paraganglioma，PGL）是源自肾上腺外嗜铬细胞的罕见肿瘤，而发生部位在子宫-膀胱间隙且术前无任何症状的相关病例更为鲜见。报道1例罕见的PGL病例，术前无头痛、出汗、高血压及心动过速等典型PGL症状。术中见肿瘤位于子宫与膀胱间隙中，触碰肿瘤时出现血压异常波动、血氧下降、室颤、房颤等心律失常，在术中稳定生命体征后进行了全子宫+双侧附件切除术，术后转重症监护病房密切监测生命体征，予以对症治疗后患者痊愈出院，出院时血压、心功能稳定，无并发症，术后2个月复查儿茶酚胺、血压、妇科彩色超声等无明显异常。通过该病例的临床特点和辅助检查情况，分析术前精确诊断要点，以降低PGL的围手术期风险，提高患者生存率。

关键词: 副神经节瘤, 儿茶酚胺类, 诊断, 治疗, 病例报告

Abstract:

Paraganglioma (PGL) is a rare tumor derived from extra-adrenal chromaffin cells. The occurrence of PGL in utero-bladder space without any symptoms before surgery is more rare. We report a rare case of ectopic pheochromocytoma without typical symptoms of headache, sweating, hypertension, and tachycardia. During the operation, we found that the tumor was located in the space between uterus and bladder, and that abnormal fluctuation of blood pressure, decrease of blood oxygen, ventricular fibrillation, atrial fibrillation and other arrhythmias occurred when touching the tumor. After stabilizing vital signs during the operation, the whole uterus plus bilateral adnexectomy was performed. After operation, the patient was transferred to ICU for close examination of vital signs, and was discharged after symptomatic treatment. The patient was cured and discharged from the hospital with stable blood pressure and cardiac function without complications. No abnormality was found in the reexamination of two months after the operation, including catecholamine, blood pressure and gynecological color ultrasound. By sorting out the clinical characteristics and auxiliary examination of this case, we analyzed the key points of preoperative diagnosis to reduce the perioperative risk of PGL and improve survival rate.

Key words: Paraganglioma, Catecholamines, Diagnosis, Therapy, Case reports

潘如, 陈紫均, 杨海坤, 余祝英, 吴生盛. 子宫-膀胱间隙异位副神经节瘤诊治一例[J]. 国际生殖健康/计划生育杂志, 2025, 44(2): 128-131.

PAN Ru, CHEN Zi-jun, YANG Hai-kun, YU Zhu-ying, WU Sheng-sheng. Diagnosis and Treatment of Paraganglioma in Utero-Bladder Space: A Case Report[J]. Journal of International Reproductive Health/Family Planning, 2025, 44(2): 128-131.

图/表 5

图1 盆腔彩色多普勒超声图注：盆腔偏右侧可见一实性为主的混合性回声团，大小约53 mm×46 mm，边界尚清，呈类椭圆形，内部回声不均，可见液性暗区，未见钙化，其内可见少量血流信号。

图2 盆腔MRI图注：图a，b盆腔右侧/子宫膀胱间隙-子宫右旁不规则囊实性肿物影，呈T1加权成像（T1WI）等/轻度低/低T2WI轻度高/高/低混杂信号影，实性部分弥散加权成像（DWI）呈欠均匀高信号，相应表观弥散系数（ADC）值降低，增强扫描实性部分呈欠均匀，明显强化、囊性部分未见强化，边界尚清。黄色箭头所示。图c盆腔MRI矢状位，病灶邻近子宫、右侧附件、膀胱、乙状结肠受压推移改变，局部紧贴。

图3 术中所见

图4 手术大体标本注：大小约5 cm×5 cm。

图5 标本病理图（HE染色×40）注：上皮样肿瘤细胞呈团巢状排列，富含血窦。标尺=50 μm。

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