摘要
目的探讨颈动脉体瘤的个体化序贯治疗。方法回顾性分析1999年1月～2009年7月诊治的23例(29侧)颈动脉体瘤患者,其中单侧颈动脉体瘤17例,双侧6例;经确诊后采用术前Matas试验-BOT试验-手术的序贯治疗方式。手术方法包括瘤体剥脱、瘤体与颈外动脉同时切除、颈内动脉切除后颈外动脉与颈内动脉远心端吻合或颈内动脉自体血管重建及颈内动脉单纯结扎。结果患者术前Matas试验结果:能持续按压阻断30 min无特殊不适者1周内17侧、2周内26侧、4周内29侧。其中2例女性患者在通过Matas训练后,于术前行BOT试验检测时出现阳性反应。所有患者颈动脉体瘤11侧肿瘤切除后动脉完好,5侧肿瘤切除同时结扎颈外动脉,6侧肿瘤切除后行颈内动脉破损直接修补,2侧肿瘤行颈外动脉与颈内动脉对端吻合,3侧肿瘤取大隐静脉及1侧取颈外静脉行颈总,颈内动脉搭桥,1侧单纯结扎颈内动脉。术后患者出现局灶性脑梗塞1例,Horner综合征5例,迷走神经麻痹6例,舌下神经麻痹3例,面神经麻痹2例,副神经麻痹1例。采用静脉重建的颈内动脉术后3～6个月复查彩超均见重建血管通畅。结论术前Matas试验-BOT试验-手术的序贯治疗方式能有效促进大脑侧枝循环建立;该序贯治疗对术中颈动脉重建是否需要采用转流手术方式提供准确依据,术中颈动脉破裂后单纯颈动脉修补及颈外动脉与颈内动脉端端吻合均不需要行颈动脉转流;仅行大隐静脉搭桥重建颈内动脉时才需要转流手术。颈动脉体瘤的个体化序贯治疗不仅避免了不转流导致造成脑缺血而产生偏瘫、昏迷等严重并发症,而且减少了盲目使用转流管所带来的血管损伤、血栓形成等风险及相关材料的浪费。
Objective To evaluate the individualized sequential treatment for carotid body tumor. Methods Clinical data of 23 patients （29 sides ） with carotid body tumor from Jan. 1999 to July 2009 was analyzed retrospectively. Of them, 14 patients were males and 9 females, aged from 29 to 57 years with a median age of 41. The tumor occurred unilaterally in 17 cases, bilaterally in 6. As the diagnosis established, the individualized sequential procedure of ＂ preoperative Matas test-BOT test-surgical treatment＂ was adopted. The methods of surgical treatment included stripping the tumor, simultaneous resection of tumor with the external carotid artery, distal end anastomosis of external carotid artery and internal carotid artery or autologous carotid artery revaseularization and carotid artery ligation alone. Results The side number with preoperative Matas test tolerance 30 minutes without special discomfort was 17, 26 and 29 in one week, 2 weeks, and 4 weeks respectively. Two female patients with successful Matas training failed to pass preoperative BOT test. All 23 patients （ 29 sides ） received surgical treatment. Of them, carotid artery kept intact in 11 sides, external carotid artery was ligated in 5, damaged internal carotid artery was directly repaired in 6, the external and the internal carotid artery was inosculated end to end in 2, carotid artery and internal carotid artery were reconstructed via bypass with great saphenous vein in 3 and with jugular vein in one, and only carotid artery was ligated in one. As for the postoperative complications, the case number of focal cerebral infarction, Homer syndrome, paralysis of the vagus nerve, hypoglossal nerve palsy, facial paralysis and accessory nerve palsy was 1 , 5, 6, 3, 2, and one, respectively. Three cases received postoperative tracheotomy. Three months after operation, ultrasound detection showed reconstruction of carotid artery with veins. Conclusion The individualized sequential procedure of ＂ preoperative Matas test-BOT test-surgical treatment＂ can effectively promote the brain collateral circulation and provide an accurate basis for carotid artery reconstruction using bypass or not. During this procedure, rupture of carotid artery can be simply repaired with carotid artery to internal carotid artery anastomosis without carotid bypass which should be adopted only in the reconstruction of internal carotid artery with saphenous vein. This sequential procedure can not only avoid serious postoperative complications such as paralysis, coma and others arising from cerebral ischemia, but also reduce unnecessary use of the bypass tube which may cause vascular injury, thrombosis and waste of material.
出处
《中国耳鼻咽喉颅底外科杂志》
CAS
2012年第4期264-269,共6页
Chinese Journal of Otorhinolaryngology-skull Base Surgery
关键词
颈动脉体瘤
Matas试验
球囊阻断实验
颈动脉重建
序贯治疗
Carotid body neoplasm
Matas test
Balloon occlusion test
Carotid artery reconstruction
Sequentialtherapy
