肿瘤合并颈动脉切除术的探讨

EXPLORATION OF TUMOR-CAROTID SEGMENT BLOCK RESECTION

肿瘤固着于颈动脉在临床实践中并非少见，如能将肿瘤与受累动脉一并切除，仍不无救治机会。通过体外或体内对患侧颈动脉压迫训练，促使大脑侧枝循环的建立，并采用脑血管造影或／和经颅多普勒血流检测仪（ＴＣＤ）检测证实合格后，可将肿瘤及受累段颈动脉作整块切除。本文报告１９８７～１９９５年间，我们按上述方法给７位患者施行本术，取得较好的效果，无手术死亡及脑血管并发症。

The tumor fixed to segment of the carotid artery block was electively resected without reconstruction of the artery after a scheduled extra or intra corporal carotid pressure training to promote the establishment of sufficient compensatory collateral circulation and its adequacy was certified by clinical and cerebroangiographic and/or transcranial Doppler (TCD) tests preoperatively. From 1987 through 1995, 1 case of metastatic thyroid carcinoma, 1 case of malignant lymphoma, and 5 cases of carotid body tumor received elective block resection and neither operative fatality nor cerebral vascular complications were observed. Follow up of these seven patients revealed that 6 of them survived free from cerebrovascular complication for 4 months-8 years after the operation except one malignant lymphoma patient who died from cachexia 1 year after receiving the operation; he did not experience cerebrovascular complications, either. Most of the patients could tolerate the block resection of the tumor fixed to carotid segment as soon as candidates were certified to be qualified by carotid pressure training and cerebroangiography and/or TCD tests, and the reconstruction of vasculature was unnecessary. The operation was thus simplified.