颈静脉球体瘤手术并发症的处理

Management of operative complications in glomus jugulare tumor surgery

目的探讨颈静脉球体瘤手术并发症的发生情况、影响因素及处理方法。方法对47例(51例次)颈静脉球体瘤手术的并发症进行回顾性研究。手术入路分别为外耳道、耳后及改良A型颞下窝入路,随访时间为术后1个月。结果51例次颈静脉球体瘤手术并发症中,重度传导性耳聋占41.2%(21/51),面瘫占29.4%(15/51),后组颅神经麻痹占27.5%(14/51),其他并发症分别为脑脊液漏5.9%(3/51)、全聋5.9%(3/51)、眩晕5.9%(3/51)、脑梗死2.0%(1/51)、耳廓部分坏死2.0%(1/51)、腮腺漏2.0%(1/51)。术前肿瘤供血血管栓塞能够明显减少术中出血。术中有效止血、低压麻醉是减少术区出血并预防并发症的重要步骤。术后发生脑脊液漏者,2例经保守治疗治愈,1例经手术治愈。结论颈静脉球体瘤手术严重并发症的发生率很低,其发生与肿瘤类型及大小有关。手术医师的经验、技巧及术前正确评估影像学资料是避免出现并发症的关键因素。

Objective To investigate the common complications related to glomus jngulare tumors surgery, their influencing factors, and to search for the effective treatments of these complications. Methods A retrospective study was undertaken on the complications observed in 47 patients with glomus jugulare tumors who underwent 51 times of operation via trans external auditory canal approach, the retroauricular approach, and modified infratemporal fossa approach type A. All cases were followed up over 1 month after surgery. Results Of 51 cases, the most frequent complication was total conductive hearing loss which occurred in 21 cases （41.2%）, facial paralysis was found in 15 cases （29. 4%） and lower cranial nerve palsy was found in 14 cases （27. 5%） after one month. Other complications were eerebrospinal fluid （CSF） leak, hearing disability and vertigo, each in 3 cases （5. 9%）; cerebral infarction, partial auricle necrosis and parotid gland fistula, each occurred in one case （2. 0 %）. Pre-operative selective embolization of feeding vessels can reduce intraoperative blond loss significantly in most cases. Effective hemostasis and hypotensive anesthesia during operation were the important ways to prevent complications and hematoma within operating field. CSF leak in this series was an uncommon complication. Two cases with CSF leak from the wound had been successfully controlled with conservative treatment. One case with CSF leak required surgical management. None of these patients developed meningitis. Conclusions There is a low level of serious post-operative complications in operation on glomus jugulare tumor. Factors found to be relevant to post-operative complications are tumor type and tumor size. The key factors to avoid the complications include surgical experience, surgical skill and preoperative evaluation of patients＇ imaging information.