颈段颈内动脉畸形的临床分析

Clinical analysis of cervical internal carotid artery malformation

目的:阐述颈段颈内动脉畸形的临床特点及临床影像学分级方法。方法:回顾性分析成都医学院第一附属医院耳鼻咽喉头颈外科2018年4月—2021年2月收治的6例颈段颈内动脉畸形患者的临床资料,并按照临床影像学分级方法予以分级。结果:6例患者均依靠增强CT或CT血管造影确诊。畸形颈内动脉与咽部黏膜最短距离为0~2.0 mm,中位距离为1.3 mm。4例口咽部颈内动脉畸形患者均属于Ⅳ级,损伤颈内动脉风险为极高危;2例下咽部颈内动脉畸形患者属于Ⅲ级,损伤颈内动脉风险为高危。结论:颈段颈内动脉畸形并不少见,增强CT或CT血管造影可明确诊断;临床影像学分级可评估损伤畸形颈段颈内动脉风险,临床意义较大。耳鼻喉科及麻醉科医师要重视此畸形,防止操作和手术过程中损伤颈内动脉,引起致死性大出血。

Objective:To introduce the clinical features and clinical imaging grading methods of cervical internal carotid artery(ICA)malformation.Methods:The clinical data of 6 cases with cervical ICA malformation admitted to the department of Otolaryngology,Head and Neck Surgery,the First Affiliated Hospital of Chengdu Medical College from April 2018 to February 2021 were retrospectively analyzed and graded according to the clinical imaging grading method.Results:All 6 patients were confirmed by enhanced CT or CT angiography.The minimum distance from deformity ICA to pharyngeal mucosa was 0–2.0 mm,while the median distance was 1.3 mm.According to the clinical imaging grading standards,the four cases with oropharyngeal ICA were gradeⅣ,which is considered extremely high risk of ICA injury.The two cases with hypopharyngeal ICA were gradeⅢ,which is considered high risk of ICA injury.Conclusion:ICA malformation is not a rare condition,and can be definitively diagnosed by enhanced CT and CT angiography.The clinical imaging grading can be used to assess the risk of damaged ICA malformation,which has great clinical significance.Otolaryngologists and anesthesiologists should pay attention to this malformation to prevent ICA damage in the operation which could lead to fatal hemorrhage.