Bladder pheochromocytoma resection

Bladder pheochromocytoma mostly grows in the junction of the ureter and the bladder, and the urethra is in the triangle. The tumor grows in the submucosal wall layer and can infiltrate into the inside and outside. Since the publication of Zimmeman in 1953, there have been many cases found at home and abroad. This is a good site for extra-adrenal pheochromocytoma. The embryonic period has a very rich paraganglia in this area and has been confirmed to be chromaffin tissue. This tissue also exists in the outer layer of the bladder wall and has been suspected to be a residual embryo derived from the adrenal medulla. This kind of tissue will be degraded and disappeared after birth, such as abnormal growth and development due to non-degeneration, which becomes bladder pheochromocytoma. Tumors can grow into the bladder, break through the mucosa and appear hematuria, and can also grow outside the bladder, compressing the ureter or bladder outlet to cause obstruction. Adrenal medullary pheochromocytoma is caused by the abnormal development of neural crest cells in the embryonic stage, so pheochromocytoma can occur in the adrenal gland or in other parts of the body rich in ganglion cells. Most common around the kidneys and adrenal glands, on both sides of the abdominal aorta and branches of the internal organs of the viscera, such as the vicinity of the celiac trunk, the gland of the Zuckerhandle at the bifurcation of the abdominal aorta, and the end of the ureter entering the bladder wall. Such as the chest, mediastinum, intracranial and other parts can also be occasionally seen. Due to the abnormal development of neural crest cells in the embryonic stage, while the pheochromocytoma is formed, the development of other endocrine gland cells may be affected and may be complicated by tumors. The thyroid gland, parathyroid gland, pancreas, and pituitary gland are the most susceptible endocrine glands. According to the different organs of the disease, Sipple is divided into I, II, and III types. Such a complicated onset phenomenon is obviously related to familial inheritance and is a result of the disorder of embryonic neural crest cell differentiation and development. The tumor cells can be malignant cancers - pheochromocytoma, or benign adenomas. Adrenal medulla cells can also develop symptoms with diffuse proliferation, but do not form pheochromocytoma (Drukker, 1957), or only form nodular proliferation or microadenomas. Pheochromocytoma (cancer) and medullary proliferation in the adrenal gland or outside the adrenal gland, in addition to secreting specific adrenaline and norepinephrine, can also synthesize and secrete other endocrine hormones, causing other types of syndromes, such as secretion. ACTH shows Cushing syndrome. Most tumors show typical symptoms of high catecholamines, but a few tumors can be asymptomatic and only begin to develop symptoms when strongly stimulated. Pheochromocytoma can be both acquired and with congenital familial genetic factors. All of the above, make pheochromocytoma the most intricate and unpredictable tumor in the human body. For more than half a century, medical scientists have been interested in its research and have become a major issue in surgical treatment. Pheochromocytoma (including medullary proliferation) has been considered a rare disease in the past. With the improvement of understanding, the improvement and improvement of various diagnostic techniques has become the most common cause of various secondary hypertension. Based on the growing clinical experience, good preoperative preparation and excellent surgical skills, the surgical cure rate of this disease has reached the best level. Treatment of diseases: bladder tumor bladder pheochromocytoma Indication 1. There is a typical onset of symptoms of pheochromocytoma during urination. If cystic neoplasms or mucosal tumors of the bladder are seen by cystoscopy, the disease can be considered and surgical treatment can be performed. 2. Due to the sudden appearance of symptoms caused by cystoscopy in hematuria, although no clear bladder tumor can be seen, surgical exploration can be performed. 3. Asymptomatic episodes of non-epithelial bladder tumors, when typical symptoms appear during surgical exploration, appropriate intraoperative treatment should be given for pheochromocytoma, and surgery should be completed in the first phase. Surgical procedure Incision Make a straight incision in the lower abdomen of the umbilical to pubic symphysis, cut the skin, subcutaneous, and rectus abdominis anterior sheath, and pull the rectus abdominis to the anterior bladder area. 2. Exploring Incision of the peritoneum, first explore the pelvic cavity, there are no more tumors around the artery and ureter changes. If no pathology is found, the peritoneum can be sutured. 3. Free bladder Take the right side of the tumor and involve the right ureteral orifice as an example. The right half of the bladder is released to the pelvic floor and up to the normal plane of the ureter. Incision of the bladder, 2 to 3 cm from the edge of the tumor to remove the tumor and the full-thickness bladder wall, and can be associated with the end of the ureter. 4. Ureteral bladder re-synchronization After the tumor was completely resected, the end of the ureter was reconciled with the bladder according to anti-reflux technique, and the stent tube was placed after anastomosis. 5. suture the incision, place drainage The bladder incision was first sutured with 3-0 absorbable line or continuous full-thickness suture, and the muscle layer of the pulp was further sutured with intermittent suture of the silk thread to perform a suprapubic bladder stoma. After the pubis, the rubber tube was drained, and the abdominal wall incision was sutured layer by layer.