颈动脉体瘤手术治疗14例分析

目的：总结1995～2003年期间14例颈动脉体瘤的诊治经验．探讨颈动脉体瘤术前准备、手术方法和并发症的防治。方法：14例颈动脉体瘤患者，13例术前行数字减影血管造影检查．其中11例行球囊阻断试验，1例行彩超检查。2例采用单纯瘤体切除；3例行瘤体与颈外动脉一并切除；3例行瘤体与颈内、外动脉一并切除，未做颈动脉重建：3例瘤体切除，同时行颈内动脉修补术；3例瘤体与颈内、外动脉切除，同时行颈内动脉重建。其中1例为恶性颈动脉体瘤，瘤体侵及颅底，行颈内动脉颅内、外动脉搭桥重建。结果：全部病例获随访，随访期1～9a，无复发病例。2例术后1周分别出现对侧偏瘫和失算，均在半年后康复。结论：颈动脉体瘤第一次手术应尽可能采用单纯剥除术：二次手术或恶性颈动脉体瘤需整块切除时，应尽可能行颈内动脉重建，必要时需行颅内、外动脉搭桥，以减少术后并发症。     

颈部动脉外伤6例的救治体会

<正> 颈部的血管较多,主要的有颈总动脉、颈内动脉、颈外动脉、椎动脉以及其他的动脉分支。颈部外伤合并大血管损伤临床上并不少见。由于颈部的重要器官结构关系密切,颈部创伤均可致严重出血,同时合并颌面、颅脑损伤,病情往往较凶险,在治疗处理上棘手,救治时间和救治不当会导致严重并发症及后果。我科在2000～2003年共救治6例,报告如下。     

颌面颈部穿透伤致知名血管损伤的急救和诊治

颌面颈部穿透伤致知名血管损伤并不少见 ,处置不当则后果严重。我科 10年来收治 8例 ,现报道如下。1　临床资料1.1　年龄与性别男 7例 ,女 1例 ,年龄 8～ 42岁 ,平均 2 3 .8岁。1 .2　致伤原因枪击伤 3例 ,电锯伤 1例 ,玻璃割伤 1例 ,刀或匕首砍伤 3例。1.3　损伤血管颈总动脉 1例 ,颈外动脉及颈内动脉 2例 ,右咽升动脉合并假性动脉瘤 1例 ,颈外动脉、面横动脉颞浅动脉 1例 ,颌内动脉 1例 ,颈外动脉、面动脉、面前静脉 1例 ,面动脉及舌动脉 1例。1.4　合并伤面神经损伤 2例 ,舌下神经损伤 1例 ,假性动脉瘤 1例 ,腮腺损伤 1例 ,颌骨骨折 2例 …     

颈动脉假性动脉瘤的DSA诊断

目的:加深对颈动脉假性动脉瘤DSA表现特点的认识,探讨其诊断价值。方法：由两名有经验的放射学医师对16例颈动脉假性动脉瘤的血管造影及临床资料进行同顾性分析。结果：16例患者经DSA检查均能明确诊断,其中颈总动脉者1例,颈动脉分叉处9例,颈内动脉5例,颈外动脉1例。DSA主要表现为：所有瘤腔内造影剂滞留,瘤腔内形成涡流者12例,动脉瘤开口处“喷射征”17例,颈动脉分叉角度增大,颈内、外动脉移位者12例。结论：DSA是诊断颈动脉假性动脉瘤最有价值的检查方法,它有利于临床治疗方式的选择。     

穿透性颈部大血管伤的救治:附6例报道

目的:探讨穿透性颈部大血管伤的救治方法。方法:1999—2010年收治6例穿透性颈部大血管伤患者,损伤的重要血管结构中颈内动脉1例,颈内静脉2例,椎动脉5例。6例患者中,5例行手术探查,1例为外伤性椎动脉假性动脉瘤,采用覆膜支架介入治疗。结果:6例患者均获得成功救治,所有患者存活,止血彻底,无继发性出血,无因脑部供血不足产生的功能障碍;2例患者颈部伤口延期愈合,分泌物非脓性,细菌培养无致病菌。结论:开放性颈部大血管伤以手术探查止血为首要治疗手段,损伤血管首选吻合,闭合性血管损伤介入血管重建值得推荐,椎动脉损伤手术填塞止血是有效的止血措施。     

颈动脉体瘤影像学特征及其产生原因

目的：探讨颈动脉体瘤影像学特征及其产生原因。方法：对12例（13侧）颈动脉体瘤病例的影像学资料进行回顾性分析。结果：颈动脉体瘤具有下列影像学特征：①肿瘤内血运丰富,多源供血;②包绕血管生长,颈动脉可受压变细,血液流速明显增高;③血管被推移,颈外、颈内动脉问距离变大。结论：颈动脉体瘤影像学特征产生的原因与肿瘤的起源、发生的部位和周围解剖环境有关。     

上颈部淋巴结恶性肿瘤影响颈鞘的CT评价

目的：评价上颈部淋巴结恶性肿瘤影响颈鞘的CT表现。方法：收集经手术和活检病理证实的上颈部淋巴结恶性肿瘤病例77例(83例病变),并对其在CT上显示的影响颈鞘及其内部血管的形式进行分类和评价。结果：CT上,病变对颈鞘及其内部血管影响的表现主要有：①颈鞘内血管受压变形者52例病变(颈内动脉1例;颈内静脉51例);②颈鞘内血管受压“消失”者13例病变(均为颈内静脉);③颈鞘内血管受压移位者67例(颈内动脉22例,颈内静脉50例);④淋巴结恶性肿瘤围绕颈鞘血管者15例。结论：上颈部淋巴结恶性肿瘤对颈鞘内部血管的影响主要表现为推移和受压变形。判断病变是否侵犯颈鞘及其内部血管,应综合考虑其CT影像表现。     

颌面颈部枪弹伤特点及救治

我院１９９５～１９９９年共收治２１例颌面颈部枪弹伤患者，均为受到近距离射击、破坏力较大。现结合创伤弹道特点谈一谈救治体会。临床资料２１例中，颌面损伤８例，颈部损伤４例，两者兼有９例。软组织损伤仅２例，占９％，其余均伴有不同程度骨组织受损。上、下颌骨骨折，颧骨、鼻骨、颈椎体骨折多数为粉碎性、不规则性。贯通伤９例、盲管伤１１例、切线伤１例。金属异物大部分未取出，仅有３例在Ｘ线荧光屏显像下取出。颈部枪伤中，有２例颌内动脉破裂损伤，１例颈内动脉破裂，分别行了颈外、颈总动脉结扎术。２１例均无颅脑外伤、无昏…     

椎动脉损伤的特点及诊治体会——附2例报道

颈部大血管伤无论在平时或战时都较常见。损伤后常常出血凶猛 ,大出血可引起失血性休克 ,也可形成颈部血肿压迫气管引起呼吸困难 ,同时还可伴有气管伤引起误吸和窒息。如不能准确地诊断 ,给予迅速合理的治疗 ,常常危及患者的生命。临床上颈部血管伤通常以颈外动脉、颈外静脉、颈内动脉、颈内静脉、颈总动脉、颈前静脉损伤多见。椎动脉损伤的患者及有关椎动脉损伤的检查、治疗报道较少。我科近年收治了 2例椎动脉损伤的患者 ,现将我们的诊治体会介绍如下 :1　临床资料病例 1,患者于某某 ,男 ,2 9岁。因左颈部刀伤、出血 2h入院。患者 1999 0 …     

头颈部鳞癌患者颈外动脉狭窄：1项前瞻性研究

头颈癌患者往往并发血管病变,但除非动脉极度狭窄,否则一般无任何症状。目前对颈总动脉及颈内动脉狭窄的研究报告较多,而对颈外动脉的研究鲜有报道,尤其是对接受微血管吻合游离组织瓣移植的患者。该文应用术前双向扫描对44例患者的双侧颈总动脉、颈内动脉、颈外动脉进行评估,结果18例无异常,尽管其余26例颈动脉分支存在异常,但仅9例累及颈外动脉,其中3例动脉存在明显狭窄(狭窄程度超过50%),狭窄程度与高血压有关(P<0.05),皮瓣危象与动脉狭窄无明显相关性(P>0.05)。结论:对拟行血管吻合游离组织瓣移植的头颈癌患者,如果患者合并颈动脉狭窄的危险因素,如高血压、动脉粥样硬化,术前应对颈外动脉及其分支行扫描评价。     

Diagnosis of blunt carotid injury in patients with facial trauma

Objectives. The purpose of this study was to review the clinical and diagnostic findings associated with blunt carotid artery injury, provide information related to clinical outcome, and report the findings of a retrospective study comparing patients with nonpenetrating and penetrating carotid artery injuries and the attendant facial injuries.Study design. Twenty-one patients admitted to the hospital nonelectively with a subsequent diagnosis of penetrating (11 patients) or nonpenetrating (10 patients) carotid artery injuries were included in the study. Records were analyzed for demographic data, mechanism of injury and time to diagnosis, neurologic status, presence of facial injuries, and outcome.Results. Five patients had facial injuries associated with a blunt carotid artery abnormality; six patients had penetrating carotid wounds. Time from carotid injury by all mechanisms to diagnosis was 20 minutes to 12 hours (mean 4 hours). Seventeen patients survived their injury.Conclusion. Patients with completely asymptomatic head injuries and severe closed-head injuries must be given careful initial evaluation and subsequent secondary evaluation. The relatively high frequency of facial injuries associated with blunt carotid injury should alert the maxillofacial surgeon to consider the diagnosis.     

犬动脉灌注方法的比较实验研究

目的：设计一种新的动脉灌注取材方法，并与传统方法进行比较。方法：6只犬随机分为3组，分别用以下方法作明胶墨汁灌注：A组（颈总动脉灌注）、B组（颈总动脉灌注＋椎动脉阻塞）、C组（颈总动脉灌注＋颈内动脉结扎）。观察灌注效果并行微血管墨汁灌注计数。结果：A、B组灌注液自椎管外溢。C组无外溢，达到血管充盈时灌注液用量最少。三种方法的墨汁灌注微血管计数在统计上无差异。结论：颈总动脉灌注＋颈内动脉结扎可以提高灌注效率。     

颌面外伤导致颈内动脉钝性损伤继发脑梗死的治疗：8例临床分析

目的 探讨重型颌面外伤导致钝性颈内动脉损伤后脑梗死的治疗策略。方法 回顾性复习2008年1月 —2013年12月本院收治的8例颌面外伤引起颈内动脉损伤后脑梗死患者的临床资料。结果 男6例,女2例;年龄19~54岁,平均36±11.95岁;受伤至我院收治时间5~8 h,平均（6.31±1.00）h;伤后均清醒,入院时6例嗜睡,2例昏睡,其中1例次日进展为昏迷,6例偏瘫;8例颌面部CT显示面部骨折,2例合并颅底骨折,1例合并下颌骨骨折;头颅CT发现颈内动脉供血区低密度缺血病灶,无颅内出血。治疗均给予阿司匹林300 mg/d,口服2周,然后改为100 mg,维持6个月,1例行开颅减压手术。6个月后GOS评价,恢复良好6例,轻残1例,重残1例,死亡0例。结论 颌面骨折合并颈内动脉钝性损伤的患者早期出现缺血导致的中枢神经系统损害表现时,应积极使用抗血小板治疗,以降低卒中引起的病患伤残与死亡率。     

Diagnosis of traumatic internal carotid artery injury: the role of craniofacial fracture

Optimally, internal carotid artery (ICA) injury associated with craniofacial trauma should be treated soon after diagnosis. However, diagnosis is difficult and often delayed. The typical symptoms and signs for diagnosis of traumatic ICA injuries are sometimes easily neglected. Clinically, some patients were initially diagnosed by craniofacial fracture nearby the course of ICA. This investigation retrospectively reviews clinical experience in patients with traumatic ICA injury with a focus on the importance of craniofacial fracture nearby the course of ICA observed on brain or facial bone computed tomography. Eighteen patients with traumatic ICA injury were diagnosed at Chang Gung Memorial Hospital, Taiwan, from June 1998 to April 2004, including 10 patients with pseudoaneurysm formation, seven patients with occlusion, and one patient with laceration. Brain or facial bone computed tomography was reviewed retrospectively. The sample included 14 (78%) patients with skull base fractures involving the intracranial course of ICA and three (17%) patients with mandibular and cervical spine fractures near the course of extracranial ICA. Only one (5%) patient did not have evident fracture. Fractures involving the carotid canal were noted in three (17%) patients. Eight patients received interventional treatments. No further interventional treatments for traumatic ICA occlusion were performed as a result of good collateral flow from contralateral ICA or large infarction noted when diagnosed. Three patients with pseudoaneurysm received expectant management. One patient with arterial laceration with extravasation received no further management. Through meticulously evaluating routine brain and facial bone computed tomography, craniofacial fracture involving intracranial or extracranial course of ICA may be an adjuvant indicator of traumatic ICA injury for early diagnosis.     

头颈外科二次游离重建受区血管选择：10年经验总结

目的：总结对头颈部进行二次游离重建受区血管的选择策略。方法：回顾分析2009年9月—2019年9月间中国医科大学附属口腔医院口腔颌面-头颈外科22例恶性肿瘤术后患者采用游离皮瓣二次重建头颈部缺损的经验,统计术中使用的受区血管、解剖时间以及吻合区与缺损区的距离等相关数据。结果：22例患者中,受区血管采用同侧颈部血管19例,其中颈横血管13例,颞浅血管3例,甲状腺上动脉+颈内静脉2例,面动脉+颈外、颈内静脉1例,对侧颈部血管3例,包括面动脉+颈内静脉2例,面动脉+颈内、颈外静脉1例。所有皮瓣完全成活且无明显并发症。结论：对于头颈外科术后需要二次游离皮瓣重建的病例,可首选颈横血管或颞浅血管作为受区血管。若两者不可用时,可打开未进行过手术的对侧颈部寻找理想受区血管;当对侧颈部也实施过颈淋巴清扫术和（或）放疗而无可用血管时,仔细探查同侧颈部解剖条件较好的血管以备吻合;而头静脉转位、静脉移植、乳内血管或胸肩峰血管等可作为最后的补救措施。     

A retrospective study in management of carotid body tumour

We report our experience of the management of 53 patients with 57 carotid body tumours from two units of oral and maxillofacial surgery in China between 1995 and 2006. Digital subtraction angiography was used most often for the confirmation of diagnosis and preoperative assessment. Fifty-one patients with 55 tumours had their tumours resected and 2 patients had radiotherapy. Of the 55 excised tumours, 14 were resected successfully without injury to the carotid artery, 25 were resected with the external carotid artery, 5 had arteriorrhaphy, and 11 resulted in sacrificing the unilateral internal carotid artery (ICA). Six patients had interposition reconstruction of the ICA. Immediately after operation 14 patients (27%) had neurological damage, which was permanent in 3 (6%), and 2 (4%) developed stroke. There were no deaths. Once the ICA is resected, vascular reconstruction is recommended to minimise neurological morbidity.     

单侧颈动脉结扎、切除16例回顾分析(英文)

目的　回顾分析 16例单侧颈动脉结扎、切除或栓塞患者的病历资料 ,重点探讨颈动脉切除的适应证、可行性、并发症以及预测颈动脉安全切除的可靠方法。方法　 16例患者中包括脑动脉瘤 3例 ,头颈部肿瘤累及颈动脉 10例 ,右侧海绵窦动、静脉瘘 1例 ,颈动脉体瘤 1例 ,颈动脉假性动脉瘤 1例。 5例患者接受一侧颈动脉紧急结扎或切除术 ,11例术前、术中接受各种检查评价 ,包括 Matas试验 ,血管钳逐步钳夹试验 ,暂时性气囊阻断试验 ,脑血管造影 ,体感诱发皮层电位 ,经颅 Doppler监测 ,r SO2 及颈动脉残压测定。结果　 16例患者中 ,术后 4例出现并发症。1例行血管钳逐步钳夹试验的患者 ,术后 3天去除血管钳时发生偏瘫 ,另3例患者在术后即刻、术后 48h和 5天分别出现偏瘫或失语。结论　术前和 (或 )术中准确判断脑血循环状况 ,是成功进行单侧颈动脉结扎、切除的关键。暂时性气囊阻断试验是目前常用且较可靠的预测方法。     

Diagnosis and surgical treatment of carotid body tumors: 25 years’ experience in China

Carotid body tumors (CBT) are rare neoplasms arising from the small chemoreceptor organ in the adventitia of the common carotid bifurcation. A retrospective survey was conducted in 33 patients, treated by curative resection of the neoplasm, from 1980 to 2005, to investigate clinical features, preoperative treatment and surgical approach, and determine the optimum management for CBT. The demographic characteristics, clinical features, surgical approach and complications were documented and analyzed. Accurate diagnosis and effective preoperative training were associated with a good surgical outcome. Carotid arteriography accurately diagnoses and evaluates the brain's collateral circulation in the circle of Willis. Ultrasonography is useful. Carotid blood flow obstruction (Matas’ training) is effective. Complete excision of the carotid system without a vascular replacement is possible only after reliable Matas’ training and objective observation of the establishment of circulation in the circle of Willis. Correct treatment of the internal and common carotid artery is important to reduce postoperative complications. The continuity of the common and internal carotid artery should be retained if possible, and carotid artery repair is recommended. Minor complications occurred in five (15%) patients and one patient died from a cause not related to the CBT at follow-up.     

Internal carotid artery thrombosis after blunt maxillofacial trauma

Two cases of internal carotid artery thrombosis associated with a maxillary Le Fort III and mandibular angle fractures after maxillofacial blunt injuries are described. Both patients had delayed neurologic deficit and hemiparesis. The diagnosis was made by carotid angiography after clinical evidence of thromboembolism. Clinical aspects and etiology, with special attention to mechanism of injury, are discussed.