颈动脉体瘤治疗中保全颈动脉连续性的处理

The disposition of keeping carotid artery continuity in treatment of carotid body tumor

目的颈动脉体瘤与颈动脉关系密切,如何处理颈动脉是手术成功与否的关键。文中总结了15例颈动脉体瘤患者手术治疗中保全颈动脉连续性的经验。方法收集南京军区南京总医院口腔科2005年3月至2013年6月收治的颈动脉体瘤患者15例,17个瘤体,其中2例患者为双侧。17个瘤体中shamblinⅠ、Ⅱ型分别6个,Ⅲ型5个。15个瘤体行单纯剥离术,其中shamblinⅡ型3个、shamblinⅢ型2个颈动脉破损后单纯修补;其余2个shamblinⅢ型瘤体行瘤体＋颈外动脉切除,颈内动脉破损处单纯缝合修补。所有患者术前均未行颈动脉压迫及球囊阻断试验。结果 15例患者17个瘤体均成功切除。手术中均完整保全了颈总、颈内动脉连续性。术后出现迷走神经损伤所致的声音嘶哑、呛咳13例,随访2年呛咳症状均恢复,1例仍遗有轻度的声音嘶哑症状;舌下神经损伤4例,患者出现伸舌偏斜症状,随访6月后均恢复。随访1～9年,15例患者均无复发。结论绝大多数颈动脉体瘤只要手术中方法得当,是可以保证瘤体从动脉壁上完整剥离,从而保全颈动脉连续性,可放弃术前颈动脉压迫训练或球囊阻断试验。

Objective Carotid body tumor is closely related to carotid artery. How to deal with carotid artery is the guaranty of successful surgery. The aim of this study was to summary the experience of keeping carotid artery continuity in the treatment of 15 carotid body tumor cases. Methods Clinical data of 15 cases with 17 carotid body tumors,in which 2 patients had bilateral tumors,were collected. The 17 carotid body tumors were classified as Shamblin I（ 6 cases）,Ⅱ（ 6 cases） and Ⅲ（ 5 cases）. Fifteen tumors were dissected simplely. Among these 15 tumors,three of Shamblin Ⅱ and two of Shamblin Ⅲ underwent repair of the break of carotid artery. The rest two of Shamblin Ⅲ underwent tumor and external carotid artery excision and internal carotid artery repairment. Matas pressing test of carotid artery or carotid artery balloon occlusion test was not performed in any patient. Results All 17 tumors were successfully excised. None of the 17 tumors underwent anastomosis or reconstruction of internal carotid artery or arteria carotis commun. The continuity of carotid artery or internal carotid artery was kept in all the patients after tumor excision. Hoarseness and bucking induced by the injury of vagus nerve occurred in 13 cases,and bucking recovery in all the cases after 2 years follow up,and only one case remained mild hoarseness. Hypoglossal nerve injury occurred in 4 cases with tongue deviation,and the symptom recovery after 6months follow up. No one had recurrent by the follow-up period ranging from 1 to 9 years. Conclusion Most carotid body tumors could be completely resected by tumor dissection method with the accurate treatment,thereby the continuity of carotid artery could be kept. The Matas pressing test of carotid artery or carotid artery balloon occlusion test is not necessarily to every patient.