颈动脉体瘤20例诊疗及手术并发症回顾分析

Retrospective Analysis of Diagnosis,Treatment and Surgical Complications in 20 Patients with Carotid Body Tumor

目的探讨颈动脉体瘤(carotid body tumor,CBT)的诊断、治疗经验和手术并发症的防治策略。方法回顾性分析2005年7月—2013年10月行手术治疗的20例颈动脉体瘤临床资料。结果本组主要表现为无痛性颈部肿物,5例伴咽部不适,2例声音低沉。均曾在外院就诊,其中5例误诊,误诊为淋巴结增大原因待查3例,颈淋巴结结核2例;6例明确诊断CBT,曾行肿物活检或尝试行肿瘤切除均失败;余9例高度怀疑CBT。20例均在我院经颈部计算机断层X线血管造影(CTA)或磁共振血管造影(MRA)检查诊断为CBT,其中双侧4例,单侧16例,共24个瘤体。20例均行手术治疗,除1个瘤体延伸至颅内未完整切除外,余23个瘤体均一期手术完整切除。围手术期无死亡发生,术后出现脑神经损伤表现13例。术后共14例获得随访,11例脑神经损伤中,7例经保守治疗完全或部分恢复,4例无明显恢复。结论 CBT临床易误诊,提示临床接诊无痛性颈部肿物应考虑CBT可能,及时行颈部CTA或MRA检查有助于诊断。早期确诊并选择适当的手术方案可减少并发症的发生。

Objective To analyze the preventive strategy of diagnosis, treatment and surgical complications for carotid body tumor （CBT）. Methods Clinical data of 20 patients with CBT undergone resection during July 2005 and October 2013 was retrospectively analyzed. Results All the patients had a painless neck mass, of whom 5 had throat discomfort and 2 had voice changes before operation. All the patients visited doctors in other hospitals, 5 patients were misdiagnosed, including 3 were misdiagnosed as having enlarged cervical lymph nodes, and 2 as having tuberculosis of lymph nodes; 6 patients were definitely diagnosed as having CBT, and underwent mass biopsy or failed resection before; the other 9 patients were highly suspected as having CBT. All the patients were diagnosed as having CBT after preoperative CT angiography （CTA） or MR angiography （MRA）, and 4 patients had bilateral lesions, and 16 patients had unilateral lesions, and 24 tumors were found in the 20 pa- tients. All the tumors were completely resected except one extending to the intracalvarium. There was no death case during pero- perative period, but 13 patients had cranial nerve injuries. There were 11 patients with cranial nerve injuries, 7 with complete or partial recovery after conservative treatment and 4 without obvious recovery during postoperative follow-up of 14 patients. Con- clusion The CBT tends to be misdiagnosed, so clinicians should consider CBT for patients with a painless neck mass, and timely cervical CTA and MRA can helpthe diagnosis. Early diagnosis and appropriate surgical methods may reduce complication rate.