中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (04): 343-345.

• 论著 • 上一篇    下一篇

颈动脉体瘤的外科治疗

吕伟明1，刘瑞磊2，李 杰1，林勇杰1，李晓曦1，王深明1   

  1. 1中山大学附属第一医院血管外科，广东广州510080；2中山大学附属第三医院甲状腺乳腺外科，广东广州510080
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-04-03 发布日期:2009-04-03

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-04-03 Published:2009-04-03

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摘要：

目的 总结颈动脉体瘤外科治疗经验。方法 回顾性分析中山大学附属第一医院血管外科1980年1月至2006年12月的59例62侧颈动脉体瘤手术，按照是否行术前供瘤血管栓塞分为两组，比较其手术方式、手术效果以及并发症发生情况；探讨转流管在颈内动脉重建中的意义；通过随访结果探讨病理学诊断意义。结果 栓塞组和未栓塞组的出血量、颅神经损伤发生率的差异均有统计学意义；11例手术病人进行颈内动脉重建，其中6例使用内转流；术后脑梗塞2例，均为使用内转流病人，其中1例死亡；21例病人术后发生27例次的颅神经损伤，占33.87%，绝大多数为暂时性损伤，仅有1例为永久性损伤。术后病理证实62侧颈动脉体瘤中59侧良性，3侧恶性，随访均未见复发和转移。结论 术前供瘤血管的超选择性栓塞可以明显的减少手术出血量，减少颅神经的损伤发生率，降低手术风险，栓塞后24～48h为手术的最佳时机；颈内动脉重建时不建议常规使用内转流。组织形态学表现不足以判定其良恶性，而应根据其生物学行为，因此对颈动脉体瘤病人必须做好随访。

关键词: 颈动脉体瘤, 术前栓塞, 内转流管

Abstract:

Surgical therapy of carotid body tumor LV Wei-ming*,LIU Rui-lei,Li Jie,et al. *Department of Vascular Surgery , the First Affiliated Hospital , Sun Yat-sen University, Guangzhou 510080 , China Corresponding author:WANG Shen-ming, E-mail:lijie3218@sina.com Abstract Objective To summarize our treatment experience of carotid body tumor. Methods Retrospectively analyze the clinical data of 59 cases(62 sides) of carotid body tumor from Jan 1980 to Dec 2006,including their preoperative preparations,operative procedures,and complications. Evaluate the value of preoperative superselective arteriography plus emboliazation before surgery. Results The intraoperative blood loss and cranial nerve injury significantly decreased in the embolism group( P < 0.01; P < 0.05).11 interal carotid artety reconstructions were carried out, internal shunts were used in 6 cases and 2 cases of them suffered cerbral infarctions(33.3%);27 injuries of cranial nerve occered in 21 pationts(33.87%),but only one permanent injury in them. Pathology reslts: 3 were malignant,others were benign;with 63 months follow-up ,no recurrence or metastasis occurred.Conclusion Preoperative superselective arteriography plus embolization may facilitate the surgical removal of CBT.Operation should be done within 48h.Internal shunts should not be used as a routine method. Histomorphology can not efficiently predict its biological behavior,so we should found a potent follow-up system.

Key words: carotid body tumor, preoperative embolism, internal shunt