Millimeter-Level Operation Amidst Five Blood Vessels! HeYou Hospital Successfully Completes High-Difficulty Pheochromocytoma Resection
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News
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2025-05-12
Sudden headache, soaring blood pressure, and a life-threatening crisis—A 54-year-old female patient, Ms. Zhang, harbored a hidden “time bomb” within her body. Imaging revealed a 4 cm pheochromocytoma in the left renal hilum, tightly encasing vital blood vessels, posing an imminent risk of fatality. Facing this medical challenge, the multidisciplinary team at HeYou Hospital rose to the occasion, launching a life-saving battle in the perilous “danger zone” dense with blood vessels. From precise preoperative preparation to a thrilling 3-hour surgery, and meticulous postoperative recovery, how did this high-difficulty treatment successfully “defuse the bomb”? Let us explore.
4 cm “Bomb” Suddenly Detonates, Blood Pressure Soars to 220, Life Hangs in the Balance!
After a period of physical labor, the 54-year-old Ms. Zhang (pseudonym) suddenly experienced severe headache, palpitations, chest tightness, nausea, and vomiting. Upon emergency admission, her blood pressure surged to 211/83 mmHg. Despite antihypertensive treatment at a local hospital, her blood pressure fluctuated erratically, even leading to shock. Ultrasound examination revealed a 3.8×4.1 cm space-occupying lesion in the left renal hilum. Due to the critical and complex nature of her condition, upon the recommendation of the local hospital, the patient was transferred to the Emergency Department of HeYou Hospital via the green channel at 1:00 AM.
Tumor Location
“The patient arrived in a state of shock, with extremely unstable blood pressure, at imminent risk of a cerebrovascular or cardiovascular accident,” described the attending physician. The emergency team immediately initiated the critical care protocol. While stabilizing vital signs, a contrast-enhanced CT scan confirmed the diagnosis of “retroperitoneal pheochromocytoma.” Due to the tumor secreting large amounts of vasoactive substances, the patient was urgently transferred to the Department of Urology for further treatment.
Tumor Location
The team led by Professor Xie Keji, Director of Urology, assessed that this 4 cm tumor was located in the anatomically complex left renal hilum, with imaging showing it was surrounded by multiple major blood vessels. “It is like defusing a bomb next to an oil pipeline,” Director Xie explained. “Preoperative CT showed indistinct boundaries between the tumor and the vascular sheath. For such patients, the surgical mortality rate without standardized preoperative preparation can reach 20%-45%, or even higher.” Further examinations confirmed that the persistent hypertension had already caused cardiac damage in Ms. Zhang, further increasing the surgical risk. Facing this complex case, the hospital immediately activated the multidisciplinary consultation mechanism.
Multidisciplinary Collaboration, Meticulous Preparation Over Two Preoperative Weeks
Led by Professor Xie Keji, experts from the Departments of Endocrinology, Cardiology, Critical Care Medicine, Anesthesiology, and Oncology rapidly formed a treatment team. After thorough discussion, a comprehensive treatment plan was formulated:
• Blood Pressure and Heart Rate Regulation: Stabilize catecholamine secretion through medication to minimize blood pressure fluctuations caused by surgical stimulation;
• Cardiac Function Assessment and Protection: Develop a specific plan for myocardial injury;
• Surgical Plan Optimization: Plan the tumor resection pathway to maximize preservation of left renal function.
Multidisciplinary Team Experts Discussing the Patient’s Condition
3-Hour Life-and-Death Struggle, Precise “Bomb Disposal” in the Vascular Maze
After adequate preparation, the surgery proceeded as scheduled. Intraoperatively, the actual situation proved more complex than anticipated: The tumor measured 6 cm × 4 cm × 4 cm, located in the left renal hilum, closely abutting the main left renal vein, left gonadal vessels, and left adrenal vein, and was highly adherent to the pancreas and adrenal gland.
Tumor Location
“The surgery was like defusing a bomb in a vascular jungle; the slightest misstep could have caused massive hemorrhage,” Director Xie described. With precise cooperation from the anesthesia team, the surgical team meticulously dissected the adhesions between the tumor and surrounding tissues, carefully avoiding major blood vessels. After 3 hours of delicate operation, the tumor was completely resected, the left kidney was successfully preserved, and surrounding organs such as the pancreas and adrenal gland were unharmed. Blood loss was controlled within a safe range.
Professor Xie Keji’s Team During Surgery
Comprehensive Care, From ICU to Discharge
Postoperatively, Ms. Zhang received 72 hours of close monitoring in the ICU. With invasive blood pressure monitoring and ventilator support, she experienced no complications such as infection or hemorrhage. After transfer to the general ward, a multidisciplinary consultation by the Comprehensive Cancer Center assessed the surgical resection as complete, requiring no subsequent adjuvant therapy. During this period, the Clinical Nutrition Department implemented stepwise nutritional support, and the Rehabilitation Department guided respiratory function training. Under systematic rehabilitation management, the patient recovered smoothly and was discharged.
Patient Receiving Monitoring and Treatment in the ICU
The successful treatment of this case fully demonstrates the capability of modern medicine in combating complex and critical diseases. Facing the “silent killer” of pheochromocytoma, with an incidence of only two per million, the Urology team, relying on exquisite surgical technique, performed precise maneuvers in the high-risk area dense with blood vessels. They not only completely removed the tumor but also successfully preserved renal function. The close collaboration of the multidisciplinary team, from precise preoperative assessment to intraoperative risk management and postoperative rehabilitation, formed a complete treatment chain. This case proves that a diagnosis and treatment model supported by specialized technology and guaranteed by multidisciplinary collaboration can bring hope of life to patients with rare and difficult diseases.
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