颈动脉体瘤的手术治疗及并发症分析体会

Experience for surgical treatment and analyzing complication of carotid body tumor

目的 分析总结手术治疗颈动脉体瘤及术后并发症防治方面的经验体会.方法 回顾性分析1996年8月-2016年6月在新疆维吾尔自治区人民医院血管外科诊治的45例颈动脉体瘤患者的病例资料,以上患者术后随访18个月,随访均在新疆维吾尔自治区人民医院血管外科住院或门诊复查形式进行,随访期间主要观察患者术后出现的并发症及恢复情况,术前2周均进行颈动脉压迫试验(Matas试验).其中男性20例(颈动脉体瘤病变位于双侧者为4例,颈动脉体瘤病变位于单侧者为16例),女性25例(颈动脉体瘤病变位于双侧者为1例,颈动脉体瘤病变位于单侧者为24例);病程0.5～6.0年,平均3年.分析术后并发症发生情况.结果 手术均成功,无围手术期死亡病例,手术治疗的45例患者中采用一种或一种以上手术方式,其中30例患者获得随访,其余15例患者失访,平均随访18个月,出现并发症包括:脑卒中1例,舌下神经损伤8例,迷走神经损伤13例,Homer综合征9例.随访患者均无复发,6个月内神经损伤症状基本恢复,1例行迷走神经与瘤体并切者随访6个月后,仍有吞咽困难和声音嘶哑.5例双侧病变者,其中3例行双侧分期切除手术,手术顺利.1例单侧切除术后出现迷走神经损伤,故未行对侧手术;1例一侧手术后失访,对侧未接受手术.结论 术后出现声音嘶哑并非喉返神经损伤所致,双侧颈动脉病变先切除小的一侧,Matas试验不能作为术中结扎颈内动脉的依据.

Objective To analyze and summarize the experience of surgical treatment of carotid body tumor and prevention of relevant complications.Methods The clinical data of 45 cases of carotid body tumor diagnosed and treated by Department of Vascular Surgery,People's Hospital of Xinjiang Uygur Autonomous Region from August 1996 to June 2016 were retrospectively analyzed.All the patients were followed up for 18 months and were followed up in Department of Vascular Surgery,People's Hospital of Xinjiang Uygur Autonomous Region inpatient or outpatient review form,the main observation during follow-up of patients with postoperative complications and recovery.Carotid compression test (Matas test) will be performed 2 weeks preoperation.There were 20 males (4 carotid body lesions located on both sides,16 carotid body lesions on the unilateral side) and 25 females (1 carotid body lesion located on both sides of the neck,neck arteriomatous lesions in unilateral patients were 24 cases),duration of 0.5 to 6.0 years,the average duration of 3 years,analysis of postoperative complications.Results All the operations were successful.There were no perioperative deaths.Among the 45 patients undergoing surgical treatment,one or more surgical procedures were used.Thirty patients were followed up and the remaining 15 patients were lost to follow-up.During an average follow-up of 18 months,complications included 1 stroke,8 hypoglossal nerve injury,13 vagal injury ard 9 homer syndrome.No recurrence of patients was followed up within 6 months,the basic symptoms of nerve injury,1 case of vagus nerve and the tumor was followed up for 6 months,there was still difficulty swallowing and hoarseness.Five cases of bilateral lesions,including 3 cases underwent bilateral staging surgery,the operation was successful.One case of unilateral excision after vagal injury,it did not contralateral surgery;one case of one-sided surgery after the lost,the contralateral did not receive surgery.Conclusions Hoarseness after operation is not caused by recurrent laryngeal nerve injury,and it was recommended that bilateran lesions with smaller one should removed firstly.Matas test could not be regarded as criterion of intraoperative ligation during the operation.