颈动脉体瘤19例临床分析

Clinical analysis of 19 carotid body tumors

目的:探讨颈动脉体瘤的临床诊断与手术治疗。方法:对19例颈动脉体瘤患者的临床资料进行回顾分析。结果:19例患者分别进行超声波、数字减影血管造影(digital substraction angiography,DSA)、磁共振成像(magnetic resonance imaging,MRI)及CT血管成像(computed tomography angiography,CTA)检查确诊。19例患者均接受手术治疗,术前行Matas试验7例,术中监测残端动脉压19例,术前、术中行脑血管多普勒(TCD)监测11例,5例采用颈总动脉-颈内动脉转流。术后4例出现暂时性舌下神经受累,1例迷走神经受累,4～8个月后症状完全恢复。无偏瘫死亡病例。结论:DSA、CTA、MRI均具有诊断价值。麻醉可采用先清醒局部麻醉,然后改用全身麻醉。术前、术中行TCD监测,术中监测残端动脉压以及采用颈总动脉-颈内动脉转流术,可确保手术成功。

PURPOSE： To investigate the diagnosis and therapeutic approaches of carotid body tumor （CBT）. METHODS： In this study, the medical records of 19 patients with carotid body tumor were reviewed retrospectively. These patients had been referred to the Department of Oral and Maxillofacial Surgery in Shandong Provincial Hospital from 1999 to 2004. RESULTS： B ultrasound, DSA, MRI, CTA were used as the modalities of diagnosis for 19 CBT cases. All patients were submitted to surgical resection of the tumor. Among them, preoperative Matas test was carried out in 7 patients. Monitoring retrograde stump pressure of internal carotid artery was performed in all the cases during the operations. 11 patients underwent TCD examination before and during operation. Internal shunt was applied in 5 cases. Postoperatively, paralysis of hypoglossal never occurred in 4 patients, paralysis of pneumogastric never occurred in one patient, no hemiplegia and death occurred. CONCLUSIONS： DSA CTA, MRI are more effective modalities to diagnose CBT. The way of choosing local anaesthesia firstly and then general anaesthesia is preferable. Monitoring of TCD, retrograde stump pressure of internal carotid artery and internal shunt application are the keys for successful Surgery.