颈动脉体瘤的外科治疗69例分析

Surgical treatment of carotid body tumor in 69 cases

目的探讨颈动脉体瘤的手术方法和生物学特性。方法复习了 6 9例 78个颈动脉体瘤的诊治。方法包括瘤体剥脱、与颈外动脉同时切除、与颈总动脉整块切除加颈动脉对端吻合或间置移植或颈外动脉与颈内动脉对端吻合、与颈总动脉整块切除和以改进的方法重建颈动脉和早年的整块切除和颈动脉结扎。结果手术死亡率 3%。术后偏瘫 1例 ,Horner综合征 9例 ,舌咽和迷走神经麻痹 9例 ,舌下神经麻痹 5例 ,面神经下颌枝麻痹 1例。在 1～ 18年 (平均 5年 )随访时 5 6例存活。家族性病变占 7% ,双侧病变 13% ,恶性变 10 % ,内分泌倾向者 3%。结论根据病情提出 5种保留颈动脉完整性的切除方法 ,包括将远侧吻合口作在瘤体的横段面上 。

Objective To explore surgical management and biological characters of carotid body tumor (CBT). MethodsSixty-nine cases of CBT with 78 lesions were reviewed. The surgical approaches were: 1. Enucleation; 2. Resection along with the external carotid artery (CA); 3. En bloc resection with CA and restoration of CA with interpositional grafting or end-to-end anastomosis or external CA to internal CA anastomosis; 4. En bloc resection and restoration of CA using an improved method; 5. CBT resection and CA ligation at initial stage. Results The operative mortality was 3%. Postoperatively, hemiplegia occurred in one case. Horner syndrome, paralysis of glossopharyngeal and vagus, hypoglossal and ramus mandibulous of the facial nerve developed in 9, 9, 5 and 1 cases respectively. Fifty-six patients at follow-up of 1～18 (5) years were alive. Family occurrence (7%), bilateral growth (13%), trend of endocrine-secretion (2.6%), and malignant changes (10%) were found. Conclusion Five approaches were adopted for treating CBT preserving or restoring CA integrity. When CA is resected together with tumor and when the tumor is too close to cranial base, the distal internal CA can be isolated at the transverse cutting area, in which an end-to-end anastomosis can be established, and then the residual tumor can be resected leisurely.