颈动脉体瘤外科治疗中颅神经和脑血管并发症的防治体会

The Cerebral Vascular and Cranial Nervous Complications of the Resection of Carotid Body Tumors.

本文报道36例共37侧颈动脉体瘤。肿瘤局限于颈动脉分叉部9侧,包绕颈内动脉2侧,包绕颈外动脉8侧,同时累及颈内、颈外动脉及颈总动脉分叉部18侧。在无颈动脉内转流条件下行37侧手术,其中单纯肿瘤切除术22侧,肿瘤连同部分颈内、颈外动脉及颈总动脉分叉部切除、自体大隐静脉移植术15侧。手术死亡占8.1%,但1983年以后无1例死亡。发生颅神经损伤占43.2%,肿瘤转移占2.8%。本文表明近10年来颈动脉体瘤切除术的手术死亡及脑血管并发症已有显著降低,今后外科技术的提高主要针对降低颅神经损伤的发生。

Between 1959 and 1994, 36 cases with carotid body tumors were resected. Nine tumors located only on the carotid bifurcation and eight tumors involved the external carotids. Eighteen tumors encircled both internal and external carotid artery. Thirty-seven tumors were resected without internal shunt. Twenty-two tumors were simply resected without any intervention of Cerebral blood supply. Fifteen tumors had to be removed with both internal and external carotid artery and auto-saphenous vein grafts were inserted at the same time. The operative mortality was 8.1%, but there has no death or stroke since 1983. The rate of postoperative cranial nerve dysfunction remains 43.2%. The malignacy rate is 2.8%. Our experience clearly demonstrates that nearly all carotid body tumors can be resected with minimal risk of stroke or death. Future refinement of surgical technique for these difficult tumors should be focused on methods to minimize cranial nerve dysfuncion.