70例颈动脉体瘤的外科诊治分析

Diagnosis and surgical treatment of carotid body tumors in 70 patients

目的 总结颈动脉体瘤外科诊断、治疗的经验和体会.方法 回顾性分析1986年5月至2008年5月22年22收治的70例颈动脉体瘤患者的诊断方法、手术方式及并发症情况. 结果 采用CT血管造影、磁共振血管造影明确诊断;63例患者（共72个瘤体）成功行外科手术切除,无手术死亡病例,术后偏瘫2例;暂时性脑神经损伤17例,永久性脑神经损伤4例.随访62例,随访率88.6%,失访8例,随访时间6个月至5年,平均（3.8±1.1）年.手术患者随访期间无死亡,2例术后局部复发,3例发生远处转移而未能手术切除的恶性颈动脉体瘤患者死亡. 结论 CT血管造影、磁共振血管造影检查是颈动脉体瘤明确诊断及术前评估的有效手段,根据肿瘤与颈动脉的关系选择适宜术式,术中充分暴露、控制出血、保护神经及维持脑供血是预防和降低手术并发症的关键.

Objective To evaluate diagnosis and surgical treatment of carotid body tumors.Methods It was retrospectively reviewed that the diagnostic approaches, surgical operation methods and its related complications in 70 carotid body tumor cases treated in our hospital from May 1986 to May 2008.Results Diagnosis was established by computer tomography angiography （CTA） or magnetic resonance angiography （MRA）. Surgical excision was successfully performed in 63 cases with 72 tumours. There were no postoperative deaths. Two cases developed hemiplegia following surgery. Temporary cranial nerve palsy occurred in 17 cases while permanent nerve palsy occurred in 4 cases. Sixty-two cases were followed-up from 6 months to 5 years. There were no deaths in operative cases, with local tumor recurrence in 2 cases and 3 cases died due to remote metastasis. Conclusion CTA or MRA is sufficient for the diagnosis and preoperative assessment of carotid body tumor and its related structures. Surgical modality should be adjusted according to the relationship between the tumor and the carotid artery. Full exposure of the surgical area,careful control of intraoperative bleeding and persistent maintainance of blood flow to the brain are important measures for successful surgery.