133例颈动脉体瘤手术危险因素分析

Surgical experience and risk factors of 133 cases of carotid body tumor

目的总结颈动脉体瘤外科手术经验,分析手术风险相关危险因素。方法回顾性分析解放军总医院第一医学中心血管外科2005年11月至2019年4月完成手术的133例颈动脉体瘤患者的临床和随访资料。结果 142侧瘤体均成功实施手术切除,围手术期及术后30 d内无患者死亡。单纯瘤体切除33侧(23.2%),瘤体切除联合颈外动脉断扎82侧(57.8%),颈内动脉重建13侧(9.2%),颈总或颈外动脉修补10例(7.0%),颈总或颈内动脉结扎4侧(2.8%)。手术并发症53例,其中颅神经损伤43例。平均手术时间161 min(60~500 min),平均出血量308 ml(20~3 000 ml)。随访时间1~162个月,随访期间无死亡病例。结论颈动脉体瘤大小及Shamblin分型是影响手术风险的相关危险因素。ShamblinⅠ型多可单纯瘤体切除,Ⅱ型、Ⅲ型往往需要断扎颈外动脉甚至重建颈内动脉,大隐静脉重建具有较好的远期通畅率。

Objective To summarize the surgical experience of carotid body tumor(CBT)and analyze the risk factors.Methods The clinical and follow-up data of 133 patients with carotid body tumor undergoing surgery at the First Medical Center of PLA General Hospital from Nov 2005 to Apr 2019 were retrospectively analyzed.Results All of 142 tumors were successfully resected.No patients died perioperatively.Thirty-three(23.2%)cases underwent simple tumor resection,82(57.8%)cases underuent tumor resection combined with external carotid artery ligation,13(9.2%)cases did internal carotid artery reconstruction,10(7.0%)cases had total or external carotid artery repairment,and 4(2.8%)cases underwent total or internal carotid artery ligation.There were 53 complications,including 43 cases of cranial nerve injury,with an average operating time of 161min(60-500 min),an average blood loss of 308 ml(20-3000 ml).The follow-up time ranged from 1 to 162 months.No death occurred during the follow-up period.Conclusions Tumor size and Shamblin typing are surgical risk factors.Most of ShamblinⅠtype tumor can do simple resection,but typeⅡandⅢoften need to ligate the external carotid artery.Use of great saphenous vein has a favorable long-term patency rate.