颈动脉体瘤手术治疗32例临床分析

目的:探讨颈动脉体瘤手术治疗的经验。方法:分析32例颈动脉体瘤患者的临床资料,统计术前检查方式及评估结果、手术方式、术后并发症。结果:术前均行数字减影血管造影(DSA)及暂时性球囊阻断试验(TBO),32例瘤体血供均来自于颈外动脉,1例患者TBO试验阳性。22例(68.8%)患者行单纯瘤体剥除,6例(18.7%)行瘤体连同包绕的颈外动脉一并切除,4例(12.5%)行瘤体及其包裹的颈总动脉分杈一并切除。无手术死亡及脑梗死病例,颅神经麻痹4例(12.5%)。结论:DSA及TBO是颈动脉体瘤明确诊断及术前评估的有效手段,根据脑动脉环代偿能力及肿瘤与颈动脉的关系选择适宜术式,术中充分暴露、控制出血、保护神经及维持脑供血是预防和降低手术并发症的关键。

二次探查成功切除颈动脉体瘤一例

1病例报告 患者女，36岁。因颈部包块10年，增长加快3个月，在当地县医院拟行包块切除，局麻下探查发现颈部包血块与颈部血管关系密切，因出血多而无法切除，随即关闭切口转入本院求治。入院检查，左颈部乳突下方胸锁乳突肌深面卵圆形肿块5cm×4 cm×4 cm大小，质地较硬，活动度较小，边界较清，压之不缩小，但能触及搏动。MBI显示：左颈部动脉分叉处包块，包绕颈总动脉分叉及颈内颈外动脉起始部，导致分叉部增宽，动脉管腔受压。临床初步诊断为左颈动脉体瘤。经数日Matas试验，达到每次压迫阻断左颈总动脉20 min能耐受。于2000年7月16日行二次手术探查。全身麻醉，头部置冰帽，颈部及右股部消毒，顺左胸锁乳突肌前缘切口，向后牵开胸锁乳突肌，

颈动脉体瘤诊治的临床分析：附38例报告

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。

DSA Diagnosis of Carotid Body Tumor

Objective: To make a further understanding of the DSA features of the carotid body tumor (CBT) and to explore the clinical value of DSA diagnosis and interventional treatment for CBT. Methods: Twelve cases of CBT with DSA data were analyzed retrospectively. The DSA appearances in all of the patients were observed dynamically in a double blind manner by two experienced radiologists together and a consensus interpretation formed. Results: DSA could establish definitive diagnosis in all cases. The DSA features of the CBT were: the increase of bifurcation angles of internal and external carotid arteries in all cases; the CBT supplied by external carotid arteries in most cases and the significant increase of tumor vessels in bifurcation; invasion of internal or external carotid arteries in 6 cases. The tumor staining disappeared mostly after the supplying arteris were embolized in 2 cases, and the bleeding during the operation reduced significantly. Conclusion: The DSA is useful in the diagnosis of the CBT and for therapeutic planning. The pre-operation embolization of the CBT contributes to reduce the bleeding during operation.

Diagnosis of carotid body tumor by digital subtraction angiography

Objective: To make a further understanding of the features of the carotid body tumor (CBT) by digital subtraction angiography (DSA) so as to explore the clinical value of DSA diagnosis and interventional therapy for CBT. Methods: DSA data from 12 cases of CBT were analyzed retrospectively. A consensus interpretation of the DSA appearances in all of the patients was reached after dynamic observation by 2 experienced radiologists in a double blind manner. Results: Definite diagnosis in all cases could be made by DSA. The DSA features of the CBT included bigger bifurcation angles of the internal and external carotid arteries, displacement of internal and external carotid arteries, CBT supplied by external carotid arteries in most cases and the significant increase of tumor blood vessels in bifurcation. Invasion of internal or external carotid arteries was found in 6 cases. Smaller stained area of the tumor and significantly reduced intraoperative bleeding were found after embolization of the supplying arteria in 2 cases. Conclusion: DSA is the effective method for the diagnosis and preoperative assessment of CBT. Preoperative embolization of CBT may contribute to the reduced intraoperative bleeding.