颈动脉分叉部肿瘤的诊断、治疗和远期随访结果：单中心回顾性分析

Diagnosis, therapeutic aspects and follow-up result of carotid artery bifurcation mass： single center clinical experience

目的总结颈动脉分叉部肿瘤的诊断及治疗经验，并观察患者的治疗效果及预后情况。方法纳入2010年1月-2017年3月在中南大学湘雅二医院血管外科收治的颈动脉分叉处肿块患者46例，其中6例行保守治疗，40例行外科手术切除，手术切下肿块均送病理检查。记录患者术后及随访时的并发症，并观察患者生存情况。结果外科手术切除40例，死亡率2.5%（1/40）。肿块大小为2-6.5 cm×2-5 cm×1-4 cm。术中发现术野内淋巴结的患者有29例（72.5%），淋巴结数为（1.94± 0.82）个。行肿块单纯切除术16例（40.0%）。颈外动脉结扎18例（45%），颈内动脉结扎1例（2.5%）。单侧迷走神经切除5例（12.5%）；行颈内动脉重建7例（17.5%）。并发症情况：8例（20.0%）患者出现声音嘶哑，4例（10.0%）出现饮水呛咳，1例（2.5%）出现脑梗死。手术并发症的严重程度与手术方式（重建颈内动脉、结扎颈外动脉和结扎迷走神经等）有明显相关性（r=0.3658, P=0.0203）。病理检查结果：31例（77.5%）为颈动脉体瘤；7例（17.5%）神经鞘瘤；1例（2.5%）血管平滑肌瘤和1例（2.5%）间叶组织肿瘤。颈动脉体瘤中1例（3.2%）为恶性。随访结果：保守治疗与手术治疗患者的长期生存率比较，差异无统计学意义（P=0.7728）。结论颈动脉分叉部肿瘤最常见性质为颈动脉体瘤。因肿块累及重要血管和神经，且其存在潜在恶性可能，需要进行手术切除治疗。患者手术后的长期生活质量满意。

ObjectiveTo summarize the experience of the diagnosis and treatment of the masses located on carotid bifurcation, and to observe the treatment effect and follow up the long-term result of the patients.MethodForty-six patients with carotid bifurcation masses treated from January 2010 to March 2017, were enrolled in this study. Of them, 6 patients were treated conservatively, when 40 patients underwent surgical resection. Regular follow up was performed for both conservative treatment patients and surgery treatment patients. The life quality and complications situation have been followed up.ResultSurgical mortality was 2.5%. The size of mass ranged as 2-6.5 cm × 2-5 cm × 1-4 cm. The lymph nodes were found in 29 patients （72.5%）, and the number of lymph node was1.94±0.82. Sixteen （40.0%） patients received mass resection without any other maneuver. Eighteen （45%） patients required external carotid artery ligation except for resection of the mass, 7 （17.5%） patients required internal carotid artery reconstruction and 1 （2.5%） patient required internal carotid artery ligation. Unilateral vagus resection was performed in 5 patients （12.5%）. And 7 patients’internal carotid arteries were reconstructed （17.5%）. Complication result： 8 patients（20%） had hoarseness and 4 patients（10%） had dysphagia. One patient （2.5%） had stroke. Surgical complications were frequent and ralated to surgical methods （arterial reconstruction or ligation of vessels/vagus） （r=0.3658, P=0.0203） . Pathological diagnosis was： carotid body tumor, 31 （77.5%）; Neurilemmoma, 7 （17.5%）; angioleiomyoma, 1 （2.5%）; mesenchymal tissue tumor, 1 （2.5%）. There was one malignant carotid body tumor （CBT） （3%）. Follow-up showed no differences between surgery and conservative treatment （P=0.7728）.ConclusionCarotid body tumors are the most common carotid bifurcation mass. Surgical removal of these tumors is necessary due to their malignant potential and compression to vessels or nerves. Long-term survival after surgery is satisfactory and comparable to conservative treatment.