在手术前对分类甲基胺产生的乳色素细胞瘤和干细胞瘤进行治疗 - - 来自DELPHI过程的结果
Nicole Bechmann1, Costanza Chiapponi2, Harald-Thomas Groeben3
1Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden 01307, Germany.
Journal of the Endocrine Society
|March 11, 2025
概括
手术前的阿尔法阻塞对于染细胞瘤和横瘤 (PPGL) 手术是常见的,但实践在很大程度上有所不同. 专家们展示了管理这些瘤的各种方法,表明需要个性化患者护理.
科学领域:
- 内分泌学 在内分泌学.
- 手术瘤学手术瘤学
- 药理学 药理学是指药理学的学科.
背景情况:
- 推使用α-上腺受体对抗剂进行手术前治疗,以治疗具有症状的分类甲基胺产生的血红细胞瘤和上腺瘤 (PPGLs),以防止上腺切除术期间发生高血压危机.
- 最近的做法质疑了这个指南的常规应用.
研究的目的:
- 评估目前在各种医疗学科中针对PPGL的手术前管理策略.
- 评估专家对PPGLs手术前治疗方法的异质性.
主要方法:
- 采用了德尔菲技术,涉及两个连续的调查.
- 一个指导小组设计了调查,46名专家通过REDCap网络应用程序参与了调查,达到74%的响应率.
主要成果:
- 虽然诊断工具和上腺切除术的指示显示出共识,但手术前使用α-上腺受体抗剂的情况有所不同:20%的人经常使用它们,50%只用于症状,约33%的人放弃了它们.
- 对于大多数专家来说,氧胺仍然是首选的药物 (63%),尽管可用更短效的替代药物.
- 治疗环境是多样化的:50%的门诊患者,13%的住院患者和37%的联合患者. 乌拉皮迪尔和尼特罗普鲁塞德是常见的手术内药物,约60%的患者在术后入院接受了重症监护或中级护理.
结论:
- 目前的手术前阿尔法上腺素受体抗剂在PPGLs的指导方针建议一般遵循,但临床实践是高度异质的,即使在专家中心.
- 手术技术和手术内管理的改进可能会支持对PPGL患者的手术前护理采取更个性化的方法.
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