颈动脉体瘤诊断与处理-单中心经验

Diagnosis and surgical treatment of carotid body tumor:A single clinical center experience

目的通过单中心颈动脉体瘤患者的临床资料分析,总结颈动脉体瘤的诊断和治疗经验。方法回顾分析17例颈动脉体瘤患者的临床资料,男7例,女10例,年龄平均39岁(25～65),均为单侧病变。结果 Shamblin分型Ⅰ型2例,Ⅱ型8例,Ⅲ型7例。术前影像学评估包括B超、CT、核磁血管成像(magnetic resonance angiography,MRA)以及数字减影血管造影(digitalsubtraction angiography,DSA)。其中16例经手术切除,手术方式包括伴或不伴颈外动脉切除的完整剥离;瘤体连同颈内-颈总动脉切除血管重建;瘤体连同颈总颈内动脉切除断端结扎;颅底颅内受累行颅内外联合入路手术。术后病理检查均为良性。随访43个月(9～108),手术并发症包括单侧喉返神经麻痹6例,其中永久性声带麻痹2例,单侧面瘫1例,单侧舌下神经麻痹2例,出血1例,脑血管意外及死亡发生率为0%。结论 DSA检查是颈动脉体瘤的重要确诊及评估手段之一。术中双极电凝的仔细分离、血管外科器械短暂的供血动脉阻断、血管外科的转流及重建技术对手术的顺利进行,降低术后并发症非常关键。

Objective To summarize the experiences of diagnosis and therapy of carotid body tumor（CBT） cases from a single center through a retrospective analysis.Methods The clinical information of 17 CBT cases was retrospectively analyzed.Among the 17 cases,7 were male and 10 females.The average age was 39（25 to 65） years.Results All lesions were unilateral.By Shamblin classification,2 cases were Type Ⅰ,8 were Type Ⅱ,and 7 were Type Ⅲ.Preoperative evaluations included Doppler ultrasound,computed tomography（CT）,magnetic resonance angiography（MRA） and digital subtraction angiography（DSA）.Sixteen cases underwent surgeries and the lesions were pathologically confirmed benign.The surgeries included total tumor removal with or without external carotid artery resection,tumor removal with carotid artery resection and reconstruction,or with carotid artery ligation,and combined approach of cranial base involved cases.After 43（9-108） months follow-up,6 cases had unilateral palsy of recurrent laryngeal nerve（37.5%）,1 case had unilateral facial palsy（6.25%）,2 cases had unilateral palsy of hypoglossal nerve（12.5%）,1 case had bleeding（6.25%）.No stroke and death happened.Conclusion DSA is a way to confirm diagnosis as well as evaluate the tumor extension.Several techniques are essential for operations and prevention of complications,such as dissection with bipolar coagulation,temporary arterial occlusion,shunt and reconstruction.