CAJ | 학술논문

目的总结颈动脉体瘤患者手术经验,提高患者生活质量.方法对2004年6月至2012年6月的36例颈动脉体瘤患者的病历资料进行分析,其中男13例,女23例;年龄9～61岁,中位数42岁;肿瘤所在位置为右侧14例,左侧19例,双侧3例(其中2例为兄妹);经颈部B超、CT、MRI和DSA检查,手术的基本术式是颌下、颈侧及胸锁乳突肌上段前缘切口.结果 36例(38侧,1例双侧病变者左侧未行手术)中29侧颈动脉体瘤完全切除,其中6侧肿瘤质地坚硬并包裹颈内动脉者在宫藤夹夹闭颈总动脉后行肿瘤和颈动脉切除;9侧质地坚硬肿瘤残留.术中出血80 ml以内17侧,100～550ml 18侧,800 ml、1000 ml和1500 ml各1侧;15侧血管栓塞中位出血量200 ml,23侧血管未栓塞中位出血量60 ml.术后神经功能障碍共10例(26.3％),含8例术前神经损伤术后神经麻痹无改善或加重者,新增术后神经损伤2例.1例恶性颈动脉体瘤术后2年随访时仍带瘤生存,其余病例经10个月至6年随访除9例失访者外均存活,肿瘤未增大.结论颈动脉体瘤首选手术切除,其质地较软者一般可完整分离切除肿瘤、保留颈内动脉,而质地坚硬且包裹颈内动脉手术时血管破裂可能性极大,术前应行DSA,确认脑血管交通支存在时,结扎颈外动脉后,置宫藤夹逐渐夹闭颈总动脉,待建立良好代偿后行肿瘤及颈动脉切除,可避免颅内并发症.
목적 총결경동맥체류환자수술경험,제고환자생활질량.방법 대2004년6월지2012년6월적36례경동맥체류환자적병력자료진행분석,기중남13례,녀23례;년령9～61세,중위수42세;종류소재위치위우측14례,좌측19례,쌍측3례(기중2례위형매);경경부B초、CT、MRI화DSA검사,수술적기본술식시합하、경측급흉쇄유돌기상단전연절구.결과 36례(38측,1례쌍측병변자좌측미행수술)중29측경동맥체류완전절제,기중6측종류질지견경병포과경내동맥자재궁등협협폐경총동맥후행종류화경동맥절제;9측질지견경종류잔류.술중출혈80 ml이내17측,100～550ml 18측,800 ml、1000 ml화1500 ml각1측;15측혈관전새중위출혈량200 ml,23측혈관미전새중위출혈량60 ml.술후신경공능장애공10례(26.3％),함8례술전신경손상술후신경마비무개선혹가중자,신증술후신경손상2례.1례악성경동맥체류술후2년수방시잉대류생존,기여병례경10개월지6년수방제9례실방자외균존활,종류미증대.결론 경동맥체류수선수술절제,기질지교연자일반가완정분리절제종류、보류경내동맥,이질지견경차포과경내동맥수술시혈관파렬가능성겁대,술전응행DSA,학인뇌혈관교통지존재시,결찰경외동맥후,치궁등협축점협폐경총동맥,대건립량호대상후행종류급경동맥절제,가피면로내병발증.
Objective To study surgical methods and techniques to reduce complications in carotid body tumors (CBT).Methods A total of 36 patients with CBT treated by the same surgeon between 2004and 2012 was reviewed.Clinical presentation,imaging,surgery techniques,postoperative complications and outcomes as well as follow-up evaluations were analyzed.Results Of 36 patients,13 males and 23 females,with a median age of 42 years (range 9-61 years).Nineteen patients had a CBT on the left side,14 on the right side and 3 on both sides.All patients (36 patients with 38 tumors) received surgical treatment.Twenty nine tumors were excised completely.Kudo clamp was used in 6 cases with solid firm tumors and potentially high risks of intracranial complications,with common carotid artery compression exercise before tumor excision.Blood loss in operation were less than 80 ml(n =17),100-550 ml(n =18),800 ml (n =1),1000 ml(n =1) and 1500 ml(n =1) respectively.There were more blood loss in cases used embolization (median of 200 ml) than in those without embolization (median of 60 ml).Post-operative local nerve impairment occurred in 10 patients (26.3％) including persistence of preexisting deficits (n =8) and newly developed deficits (n =2).Twenty-seven patients were followed up for 10 month to 6 years with a mean period of 24 months and 9 patients lost of follow-up.One patient with malignant CBT survived with tumor and other 26 patients were alive with no recurrence.Conclusions Surgery is the first choice of treatment for CBT.Soft CBT often can be excised completely with preservation of the internal carotid artery (ICA),whereas solid firm CBT encasing the ICA should be evaluated with DSA preoperatively to determine the presence of communicating branches of cerebral vessels,due to the high risk of major vessel compromise.Two-stage operation is often required,in which the ICA is gradually closed following ligation of the extemal carotid to establish collateral circulation,followed by excision of the tumor and IAC,so that serious intracranial complications can be avoided.