颈动脉肿瘤术前大脑Willis环状况判定的临床研究

Judgment of Willis Arterial Circle Condition before Surgical Management of Carotid Artery Tumor： A Preliminary Clinical Study

目的：探讨颈动脉瘤和颈动脉体瘤手术治疗前大脑Willis动脉环侧支循环状况判定的方法和标准,评价DSA全脑血管造影方法判定一侧颈动脉（颈内动脉）术中永久性阻断的安全性.方法：本组颈动脉瘤和颈动脉体瘤患者共14例,均行CT平扫、CT增强扫描和CTA血管成像三维重建,9例行DSA全脑血管造影检查.8例行手术治疗,3例保留颈总动脉和颈内动脉剥除肿瘤、5例颈总动脉（颈内动脉）连同肿瘤一并切除;4例术中同步行脑电图监测.分析术前颈动脉压迫训练后DSA全脑血管造影、术中脑电图监测等方法评价大脑侧支循环的可行性和可靠性.结果：8例手术患者中,无死亡病例,切口均一期愈合.术后均获随访3月～5 a,肿瘤相关症状消失,无肿瘤复发,其中1例术后出现偏瘫、失语,半年后康复.结论：DSA全脑血管造影检查是颈动脉肿瘤术前判断大脑Willis环侧支循环状况的重要方法,但不能作为判定一侧颈动脉结扎、切除安全性的＂金标准＂.

Objective：To investigate and reevaluate the methods and standards of judging the collateral circulation condition of cerebral Willis arterial circle before surgical management of carotid arterial aneurysm and carotid arterial body tumor with DSA. Methods： CT scan, enhanced CT scan and 3D CT reconstruction were performed in 14 patients diagnosed with carotid arterial aneurysm and carotid arterial body tumor. There were 9 patients performed cerebral DSA examination, 8 patients performed surgical operation, There were 3 patients excised tumors with the carotid artery and internal carotid artery intact, 5 cases resected tumors, carotid artery and internal carotid artery adhesively. 4 cases monitored with EEG within surgical process in the total of 14 patients. Results ：8 cases of operation patients, no death case, incision healing period. Postoperative were followed - up 3 months - 5 a, tumor - related symptoms disappeared, and no tumor recurrence. One patient developed stroke with bemiplegia and aphasia, who recovered six months later. Conclusions：The cerebral DSA examination is an important method to evaluate the collateral circulation condition of cerebral Willis arterial circle before surgical management of carotid arterial aneurysm and carotid arterial body tumor. But there is not the ＂golden standard＂ of the security with one - side carotid and internal carotid artery resection.