颈动脉体瘤诊治的临床分析：附38例报告

Clinical analysis of diagnosis and treatment of carotid body tumor: a report of 38 cases

目的:总结颈动脉体瘤(CBT)的临床特征与诊治经验。方法:回顾性分析2008年10月-2019年4月在中南大学湘雅医院血管外科治疗的38例CBT患者资料,其中男14例,女24例;年龄23~76岁;单侧36例,双侧2例;40个瘤体中,Shamblin Ⅰ型6个、Ⅱ型12个、Ⅲ型22个。结果:所有患者均行颈部CTA或MRA明确诊断。38例患者中,3例单侧患者行保守治疗,其余35例患者共37个瘤体行手术切除治疗,其中1例手术患者术前行DSA检查并行双侧颈外动脉栓塞术。无术中死亡病例,手术平均时间(140±48)min,术中平均出血量(194±148)m L;Shamblin Ⅰ型病变均行单纯CBT切除,Shamblin Ⅱ 、Ⅲ型病变行单纯CBT切除或CBT切除+其他手术(颈部动脉离断、重建、结扎)。所有手术患者术后病理检查均证实为颈部良性副神经节瘤。术后发生短暂脑神经损伤8例,永久脑神经损伤2例,死亡1例。单纯CBT切除患者的神经损伤发生率明显低于CBT切除联合其他手术患者(P<0.05)。随访半月至10年,手术患者未出现肿瘤复发及其他并发症。3例保守治疗患者均带瘤生存。结论:CTA或MRA为诊断CBT的首选方法,手术切除是CBT的首选治疗方法。手术方式的选择还需根据瘤体的大小形态以及分型决定。

Objective: To summarize the clinical characteristics of carotid body tumor(CBT) as well as the diagnostic and treatment experience.Methods: The clinical data of 38 CBT patients treated in the Department of Vascular Surgery, Xiangya Hospital, Central South University during October 2008 to April 2019 were retrospectively analyzed. Of the patients, 14 cases were males and 14 cases were females, with age ranging from 23 to 76 years;36 cases had unilateral lesion and 2 cases had bilateral lesions. In the 40 tumors, 6 were classified as Shamblin type Ⅰ, 12 were type Ⅱ and 22 were type Ⅲ.Results: Definitive diagnosis was made in all patients by neck CTA or MRA. Of the 38 patients, 3 cases with unilateral lesion underwent conservative treatment, and the remaining 35 cases with a total of 37 lesions underwent surgical resection, of whom, one case underwent DSA examination and embolization in bilateral external carotid arteries. No death occurred during operation, the average operative time was(140±48) min and intraoperative blood loss was(194±148) m L. All Shamblin type Ⅰ lesions were treated by simple CBT resection, and the Shamblin type Ⅱ and Ⅲ lesions were treated by simple CBT resection or CBT resection combined with other procedures(division, reconstruction or ligation of the carotid arteries). All the resected lesions were diagnosed as benign paraganglioma by postoperative pathology. Transient cranial nerve injury occurred in 8 patients, and permanent cranial nerve injury occurred in 2 patients, and death occurred in one patient after operation. The incidence of cranial nerve injury was higher in patients undergoing simple CBT resection than that in patients undergoing CBT resection plus other procedures(P<0.05). All patents were followed up for half a month to 10 years, no tumor recurrence or other complications were noted in patients undergoing surgical treatment, and the 3 patients receiving conservative treatment still had their tumor, but they were alive.Conclusion: For CBT, CTA or MRA is the first diagnostic option and surgical resection is the first treatment option. The selection of surgical procedures should be made based on the size and shape as well as the classification of the tumor.