颈动脉体瘤切除术后神经并发症的高危因素分析

Risk factors of neurologic complications after surgical resection of carotid body tumor

目的探讨颈动脉体瘤(carotid body tumor,CBT)切除术后神经并发症的高危因素。方法回顾性分析1991至2016年间行CBT切除术后出现神经并发症患者的临床和随访资料,使用回归分析探讨术后神经并发症(包括颈交感神经损伤)的高危因素。结果共有132例患者(142侧病变)接受手术。其中,45例(46侧病变)术后表现为神经并发症,包括4例脑梗死,44侧神经损伤(2例同时合并脑梗死及神经损伤)。经过积极的康复治疗,仅18侧遗留神经损伤(永久性损伤),4例脑梗死患者逐渐恢复自理。多因素回归分析显示高位病变(OR=4.345,P=0.005)和ShamblinⅢ型病变(OR=4.382,P=0.047)为术后颅神经损伤并发症的高危因素。高位病变(OR=7.290,P=0.001)术后永久性神经损伤并发症的风险更高。结论通过规范的康复治疗,术后神经并发症可以获得部分甚至完全缓解;突发颈动脉破裂是脑梗死的高危因素;ShamblinⅢ型及高位病变是术后颅神经损伤的高危因素。

Objective To investigate risk factors of nerve injury after carotid body tumor resection.Methods From 1991 to 2016,the clinical data of patients with neurologic complications after resection of carotid body tumor was retrospectively analyzed.Logistic regression analysis was used to investigate the risk factors of nerve injury.Results A total of 132 patients with 142 tumors underwent surgery.45 patients(46 sides)suffered nerve injury,including 4 strokes and 44 nerve injuries.After active rehabilitation,18 cases were left with permanent nerve injury,and the 4 patients with strokes regained self-care ability.By multivariate regression analysis,high-lying tumors(OR=4.345,P=0.005),ShamblinⅢtumor(OR=4.382,P=0.047)increase the risks of postoperative nerve injury.Resection of high-lying tumors carried a higher risk of developing permanent nerve injury(OR=7.290,P=0.001).Conclusions Neurologic complication could be alleviated by rehabilitation.Intraoperative abrupt rupture of carotid artery is the leading cause of stroke.ShamblinⅢand high-lying tumor are the predictors of postoperative nerve injury.