颈动脉体瘤21例外科诊治体会

Diagnostic and surgical treatment of carotid body tumor： a report of 21 cases

回顾性分析21例颈动脉体瘤（CBT）患者的临床资料。所有患者术前均经影像学检查诊断，单侧病变20例，双侧病变1例。20例行手术治疗，其中11例行单纯瘤体切除，6例行瘤体连同颈外动脉切除，3例行瘤体切除并血管重建。围手术期无手术死亡病例，术后出现颅神经损伤表现5例。术后病理学检查均诊断为CBT，其中1例为恶性。随访3个月-7年，随访率为85％。5例颅神经损伤者均于随访3个月后完全恢复，1例双侧病变于术后1年在外院行对侧瘤体切除，1例恶性肿瘤术后3年因多发转移死亡，其余病例均无复发。CBT临床易误诊，术前超声、数字减影血管造影（DSA）、CT血管造影（CTA）或磁共振血管造影（MRA）等对诊断和手术安全性评估有重要意义。手术切除是治疗CBT的首选和有效方法。

The clinical data of 21 patients with carotid body tumor （CBT） were analyzed retrospectively. The lesions were unilateral （n = 20） and bilateral （ n = 1 ）. Among 20 surgical cases, the procedures included tumor resection alone （ n = 11 ）, tumor resection along with external carotid artery （n = 6） and vascular reconstruction of carotid artery after resection of tumor body （ n = 3 ）. No mortality occurred during perioperative period. CBT was confirmed by pathologic examination in all cases and 1 case was malignant. Follow-up period ranged from 3 months to 7 years and the follow-up rate was 85%. Five cases of cranial nerve impairment recovered completely over 3 months. One case of bilateral CBT underwent contralateral tumor resection at another hospital 1 year later and 1 case with malignant tumor died from metastases 3 years later. The remainder survived recurrence-free. CBT tends to be misdiagnosed. Therefore ultrasonography, digital subtraction angiography （DSA）, CT angiography （CTA） or magnetic resonance angiography （MRA） are important for preoperative diagnosis and evaluation. Surgical resection is a first choice for CBT.