CAJ | 학술논문

目的：探讨头颈部迷走神经副神经节瘤的临床特点、诊断与治疗方法。方法回顾分析我院于2003年1月至2013年12月诊治的8例迷走神经副神经节瘤患者临床资料，结合文献复习，对该病的临床特点、诊断与治疗经验进行探讨。结果8例患者主要以声嘶和颈部包块为特点，其中7单发，1为多发副神经节瘤，7例为良性副神经节瘤，1例伴有淋巴结转移。散发患者7例，1例为家族性发病。6例肿瘤位于颈动脉分叉和颈静脉孔之间的上颈部或局限于颈静脉孔区，2例为咽旁的巨大肿瘤且其中1例伴有颅内侵犯，1例多发副神经节瘤患者同时伴有颈动脉体瘤。5例患者进行了琥珀酸脱氢酶相关基因筛查，3例患者携带有突变。结论迷走神经副神经节瘤的临床特点与颈动脉体瘤和颈静脉球瘤有相似之处，需加以鉴别。CTA和增强MRI对定性诊断有价值，增强MRI和颞骨CT则能提供较多的手术所需信息。根据肿瘤位置的不同，选择颈侧入路或辅以Fisch A型颞下窝入路切除肿瘤。迷走神经副神经节瘤有一定恶性倾向，需注意全身筛查和随访以及家系检查。
목적：탐토두경부미주신경부신경절류적림상특점、진단여치료방법。방법회고분석아원우2003년1월지2013년12월진치적8례미주신경부신경절류환자림상자료，결합문헌복습，대해병적림상특점、진단여치료경험진행탐토。결과8례환자주요이성시화경부포괴위특점，기중7단발，1위다발부신경절류，7례위량성부신경절류，1례반유림파결전이。산발환자7례，1례위가족성발병。6례종류위우경동맥분차화경정맥공지간적상경부혹국한우경정맥공구，2례위인방적거대종류차기중1례반유로내침범，1례다발부신경절류환자동시반유경동맥체류。5례환자진행료호박산탈경매상관기인사사，3례환자휴대유돌변。결론미주신경부신경절류적림상특점여경동맥체류화경정맥구류유상사지처，수가이감별。CTA화증강MRI대정성진단유개치，증강MRI화섭골CT칙능제공교다적수술소수신식。근거종류위치적불동，선택경측입로혹보이Fisch A형섭하와입로절제종류。미주신경부신경절류유일정악성경향，수주의전신사사화수방이급가계검사。
Objective To discuss the diagnosis and treatment of vagal paraganglioma (VP) in the head and neck region. Methods Eight patients diagnosed with head and neck vagal paraganglioma in our department between 2003 and 2014 were in-cluded in this retrospective study. We carried out analysis of clinical characteristics and genetic screening results in 5 of the 8 patients. The diagnosis and treatment of head and neck vagal paraganglioma were discussed. Results The most common clini-cal symptoms of vagal paraganglioma in these patients were hoarseness caused by vocal cord paralysis and a mass behind the mandibular angle. Seven patients had benign paragangliomas, while the other one had lymph node metastasis. Six of the 8 pa-tients had paragangliomas around the jugular foramen area. In the other 2 cases, the large size tumors were located in the para-pharyngeal space. One patient had both vagal and carotid paragangliomas and was also a familial case. Three patients were found to carry mutations in the coding gene for succinic dehydrogenase subunit D. Conclusions The relationship among the tu-mor, internal carotid, jugular foramen and tympanum on CT and MR images is the key to differential diagnosis of vagal para-ganlioma, glomus jugular tumour and carotid body tumor. Lateral cervical approach or infratemporal fossa approach can be ap-propriate depending on the location of the tumor’s upper pole. Genetic consultation should be recommended to all patients for better understanding of the genotype and familial screening.