Treatment of pheochromocytoma consists of two stages: conservative and surgical. Conservative treatment is necessary as a preparatory preoperative stage before the forthcoming operation.
Conservative treatment of pheochromocytoma
Regitin and tropafen are used to normalize blood pressure before surgery, as these drugs reduce the sensitivity of the body to adrenaline, which in excess and increases the pressure. After the normalization of the pressure, the preparations continue to be used, but at a lower concentration, right up to the operation itself.
In addition to pressure, tachycardia, often associated with arrhythmia, is needed in drug therapy. For this use obzidan, anaprilin, indiral and propranolol, but the normalization of heart rate should only after the normalization of blood pressure, otherwise the use of these medications can increase the already high blood pressure, causing a crisis or stroke.
Sometimes in the treatment of patients using a-methylparathyrosine, taking 1 g per day can not only block catecholamines, but also reduce the tumor and normalize the pressure. Reduce the emission of catecholamines into the blood can be, by appointing a method of nicardipine or nifedipine, which normalizing the pressure, in parallel prevent the entry of calcium pheochromocytoma cells into the cells.
Since the source of hormone production is removed during the operation, there is a danger of a catecholamine crisis, an intravenous infusion of phenoxybenzamine is prescribed 3 days before the operation, after the first reception of which the patient is prescribed apaprilin twice a day for 40 mg. But if the tumor does not increase, but lowers the pressure, then phenoxybenzamine is contraindicated for such patients.
In addition to the use of a-methylparathyrosine and phenoxybenzamine in preoperative therapy, these drugs, together with 131I-methiodobenzylguanidine, are used in the treatment of malignant pheochromocytoma with multiple metastases.
Operative treatment of pheochromocytoma
Surgical treatment of adrenal tumor is carried out in two ways:
- Open access.
For the first type of operations, either lateral or median access is used, depending on the indications. Usually, it is decided to resort to open access if the pheochromocytoma is malignant, outside the adrenal, multiple or bilateral. The doctor uses the average access if there is a risk of bleeding, or access to both adrenal glands is necessary. Side access is used if the operation will occur only on one adrenal.
The median incision is fraught with the risk of damage to the internal organs and postoperative adhesions, while the lateral inconvenience is limited by the limited view and impossibility of early adrenal vein ligation.
In recent years, laparoscopic adrenalectomy is increasingly used for surgical intervention, which allows to significantly reduce the time of postoperative inpatient treatment of a patient and blood loss during the period of surgical intervention. This operation is considered difficult in technical terms, since there is a difficulty in separating the adrenal from surrounding tissues. Such an operation is advisable if the tumor is single and does not exceed 6 cm in size. If, during surgical treatment by a laparoscopic method, the surgeon is not sure that he can finish the operation, then laparoscopy goes into open surgery.
The decision, which type of intervention to apply, should be made by the attending physician, based on individual indicators for each patient.
Removal of pheochromocytoma
The main purpose of the operation to remove pheochromocytoma is the elimination of a malignant tumor, the development of which significantly worsens blood pressure and increases the likelihood of developing serious complications( heart attacks, strokes, etc.).In modern medicine, three main methods of such treatment are used: open surgery, laparoscopic access and retroperitoneoscopic access.
Removal of pheochromocytoma is performed only after preliminary medical preparation of the patient. Such a solution allows to avoid occurrence of negative risks during surgical manipulations and promotes the patient's early recovery. The duration of the operation is usually about 2 - 2.5 hours and is determined by the neglect of the disease.
Removal of pheochromocytoma requires a great deal of practical experience and an excellent knowledge of the anatomy of the lumbar part of the body, so this intervention is carried out only in specialized centers, whose doctors are well aware of the specific treatment of such diseases.