颈动脉切除术的临床研究

A clinical study of carotid resection

目的探讨颈部恶性肿瘤侵犯颈总动脉和/或颈内动脉以及颌面部难控制大出血时对颈总动脉和颈内动脉的外科处理方法及其并发症、后遗症的预防。方法回顾性分析1990年～2000年行颈总或/和颈内动脉结扎、切除术的6例临床资料。结果 本组均为男性,年龄17～66岁。其中颈部复发性转移癌浸润颈总动脉、颈内动脉3例,鼻咽癌放疗后颈部溃疡侵犯颈总动脉1例,上颌骨中央性血管瘤大出血1例,鼻咽纤维血管瘤术中、术后大出血1例。单纯结扎、切除颈总动脉4例,颈总及颈内动脉同时结扎、切除2例。经随访,术后短暂性肢体偏瘫2例,脑梗塞、永久性偏瘫1例,无任何并发症3例。无手术死亡病例。结论颈动脉切除术对已累及颈动脉的颈部恶性肿瘤是一种有效的治疗手段,对于颌面颈难以控制的致命性大出血是一种有效的急救措施。单纯切除颈总动脉所产生的术后并发症的发生率比颈总动脉和颈内动脉同时切除低;而已先期或同时切除颈外动脉者,出现并发症的机会更大。术后酌用抗凝或溶栓药物对于脑血栓、脑梗塞的防治作用有待进一步研究。

ObjectiveTo investigate the surgical treatment of carotid, the prevention of complication and sequel afterresecting carotid when the arteria carotis communis or/and internal carotid artery were infiltrated by malignant neoplasm.Methods Six clinical cases from 1990～2000 were analyzed retrospectively.ResultsAll cases were male, the agewas 17～66 years old. The neck metastatic carcinoma were 3 cases, radiative ulcer in the neck of nasopharyngeal carci-noma 1 case, angiofibroma of nasopharynx 1 case, central hemangioma of the maxilla 1 case. The ligation and resection ofarteria carotis communis were performed in 4 cases, arteria carotis communis and internal carotid artery 2 cases. Follow-up from 3 months to 11 years, brief incomplete paralysis was 2 cases, the persistent hemiplegia resulted by cerebralinfarction was 1 case, no complication 3 cases. There was no death cases resulted by the carotid resection in the material.ConclutionsThe carotid resection is a more effective treatment on the neck malignant neoplasm that have infiltratedthe arteria carotis communis or/and internal carotid artery. The complications of pure resection of arteria carotis commu-nis are lower than those of the resection of arteria carotis communis and internal carotid artery.