个体化选择颈动脉体瘤手术方式的疗效分析

Analysis of curative effect of individualized selection of surgical methods for carotid body tumors

目的分析颈动脉体瘤(carotid body tumor,CBT)手术切除的安全性及术式选择。方法回顾性分析自2013年1月至2018年12月期间,郑州大学第一附属医院腔内血管外科手术切除的21例颈动脉体瘤患者的临床资料。根据术前影像学检查结果对CBT分型,选择外科或复合手术方式进行治疗,记录术中出血量、手术时间等,颈动脉是否阻断及术后并发症发生情况。结果共完成单纯CBT切除术4例与CBT切除+人工血管重建术3例,术前单纯弹簧圈栓塞颈外动脉+CBT切除术5例,微球栓塞颗粒+弹簧圈栓塞颈外动脉+CBT切除术4例,临时球囊阻断颈外动脉+CBT切除术5例,所有瘤体顺利剥离,技术成功率100%。术后早期出现脑梗塞3例,患者接受药物治疗后四肢肌力恢复,未留后遗症;有神经损伤表现的患者4例(吞咽困难、声音嘶哑等),21例中无死亡病例,复合手术患者围术期内支架内血流通畅,1例术后1年复查支架闭塞。分析结果显示单纯切除与"栓塞+切除"的手术时间、术中出血量差异无统计学意义(P>0.05);不同栓塞方式的手术时间、术中出血量差异无统计学意义(P>0.05);不同重建情况颈内动脉修补率差异有统计学意义(P<0.05),应用Viabahn覆膜支架优于其它两种情况。不同重建术后并发症发生率、手术时间差异无统计学意义(P>0.05);不同分型术后并发症、手术时间、术中出血量差异有统计学意义(P<0.05),III型CBT手术时间最长、出血量最多、术后并发症发生率最高。结论据CBT病变分型选择合适的手术方式,可提高手术安全性及降低颈动脉阻断的风险。

Objective To analyze the safety and surgical choice of carotid body tumor(CBT).Methods The clinical data of 21 patients with carotid body tumor who underwent endoscopic vascular surgery in the First Affiliated Hospital of Zhengzhou University from January 2013 to December 2018 were retrospectively analyzed.According to the results of preoperative imaging examination,CBT was classified,and surgical or compound surgery was selected for treatment.The intraoperative blood loss,operation time,carotid artery occlusion and postoperative complications were recorded.Results Achieved a simple CBT resection in 4 cases and CBT resection plus artificial blood vessel revascularization in 3 patients,preoperative pure spring coil embolization+CBT external carotid artery resection in 5 cases,microsphere embolism particles+spring coil embolization+CBT external carotid artery resection in 4 cases,temporary balloon block+CBT external carotid artery resection in 5 cases,all tumors had smooth stripping,technical success rate of 100%.Early postoperative cerebral infarction occurred in 3 patients.The muscle strength of the limbs was recovered after drug treatment without any sequelae.There were 4 patients with postoperative manifestations of nerve injury(dysphagia,hoarseness,etc.),and 21 patients did not die.Perioperative blood flow in the stent of patients undergoing complex surgery was unobstructed,and stent occlusion was reexamined in 1 case one year after operation.The results showed that there was no significant difference in operation time and intraoperative blood loss between simple resection and"embolization+resection"(P>0.05).There was no significant difference in operative time and intraoperative blood loss among different embolization methods(P>0.05).The repair rate of internal carotid artery was significantly different under different reconstruction conditions(P<0.05),and Viabahn coated stent was superior to the other two conditions.There was no significant difference in the incidence of complications and operation time between different reconstruction operations(P>0.05).There were statistically significant differences in postoperative complications,operative time and intraoperative blood loss among different types(P<0.05).Type III CBT had the longest operative time,the highest amount of blood loss and the highest incidence of postoperative complications.Conclusion According to the classification of CBT lesions,appropriate surgical methods can improve the safety of surgery and reduce the risk of carotid artery occlusion.