颈总动脉和/或颈内动脉切除术(附6例分析)

The resection of common or/and internal carotid artery (Analysis of 6 cases)

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的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1990～1998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,无出现术中死亡病例。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,不仅有利于完整切除肿瘤和颈清扫,且可阻断癌细胞赖以生存的血供、消灭肿瘤的亚临床病灶;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。

Purpose To investigate the surgical treatment for carotid artery and the prevention of complications and sequelae after resecting carotid when infiltrated by malignant neoplasm. Methods Six clinical cases from 1990 to 1998 were analyzed. Results All cases were male, and the age was 17 - 66 years old. 3 cases were the neck transfer carcinoma,one case was radiative ulcer in the neck of nasopharyngeal carcinoma, one case was angiofibroma of nasopharynx, and one case was central hemangioma of the maxilla. 4 cases were the ligation and resection of common carotid, and 2 cases were the ligation and resection of common and internal carotid. After following up from 3 months to 11 years, 2 cases were brief incomplete paralysis, one case was persist hemiplegic paralysis resulting from cerbral infarction, and 3 cases had no complications. There was no death cases resulting from the carotid resection. Conclusion The carotid resection is a more effective treatment for the neck malignant neoplasm that has infilitrated the common or/and internal carotid. Not only is it helpful in completely resecting tumour, but also in cutting blood provision of carcinoma cells, in destroying the cryptic focus, and in controlling the fatal hemorrhage. The complication of pure resection of the common carotid were fewer than those of the resection of the common and internal carotid.