双侧颈动脉体瘤的手术治疗

Surgical treatment of bilateral carotid body tumors

目的探讨双侧颈动脉体瘤的手术治疗。方法回顾性分析北京大学人民医院1994年以来收治的5例双侧颈动脉体瘤患者的临床资料。男1例，女4例，2例女性为姐妹，年龄26-48岁，平均（37±10）岁。5例患者均表现为双侧颈部无痛性肿物，术前行喉镜检查了解声带活动情况，双侧肿瘤均分次切除，先切除肿瘤体积较小一侧。2例Shamblin Ⅰ型和2例Shamblin Ⅱ型行单纯肿瘤切除；3例Shamblin Ⅱ型行肿瘤加颈外动脉切除；3例Shamblinm型切除肿瘤并行颈内动脉重建，2例应用自体大隐静脉，1例应用直径6mm人工血管，动脉重建过程中使用转流管保持颈内动脉血供。结果5例患者双侧肿瘤均完整切除，病理证实为良性颈动脉体瘤，无肿瘤残留者，未发生脑缺血并发症，未出现颈部血肿，未出现压力感受器调节失效综合征，2例术后出现颅神经损伤。随访时间6-39个月，平均（25±13）个月，未发现肿瘤复发和转移，3例颈内动脉重建者未发现颈动脉血栓形成。结论双侧颈动脉体瘤分次手术切除是安全的，颈动脉转流管有助于术中肿瘤切除。

Objective To investigate surgical treatment of bilateral carotid body tumors （CBTs）. Methods Five cases of bilateral CBTs were treated in our hospital since 1994. There were 4 females and 1 male with 2 being whole sisters. Age ranged from 26 to 48 years averaging at （37 ± 10） years, Tumors were painless in all cases, and indirect laryngoscopy was performed to assess the vocal cords before operation. CBTs were not resected in the same time and we always removed the smaller lesion first. Simple resection of CBTs were performed in 2 Shamblin Ⅰ and 2 Shamblin Ⅱ tumors. Resection of CBTs with external carotid artery in 3 Shamblin Ⅱ tumors. Resection of CBTs with carotid reconstruction in 3 Shamblin Ⅲ tumors （ using great saphenous vein in 2 tumors and 6 mm blood vessel prosthesis in Ⅰ tumor）. We used carotid artery shunt to maintain internal carotid blood in all reconstruction procedures. Results All tumors were removed completely and histology of the masses were benign carotid body tumors. No complication of cerebral ischemia and hematoma in neck was encountered. There was no postoperative baroreceptor failure syndrome. Cranial nerve injuries were encountered in 2 cases. 6 month to 39 months （mean 25 ± 13 months） follow-up found no recurrence and metastasis. No thrombosis was found in cases of carotid artery reconstruction. Conclusions It is safe to resect bilateral carotid body tumors separately. Temporary carotid artery shunting is suggested during the procedures.