颈动脉体瘤的手术治疗——附10例临床分析

目的：总结10例11侧颈动脉体瘤的手术经验。方法：术前9例做数字减影血管造影（DSA）检查，其中3例行暂时性球囊阻断试验（TBO）；10例10侧行颈动脉压迫训练（Matas试验）。术中9例9侧先在局麻下阻断颈总动脉30min，边手术边观察患者反应，再改为全麻下手术；单纯瘤体剥除5侧，行瘤体合并颈动脉分权切除的6侧中，颈动脉修补1例、颈动脉重建2例、结扎颈总和颈内动脉3例。结果：随访1～20a，无复发和死亡病例。1例双侧颈动脉体瘤患者右侧术后当天出现左侧偏瘫，1a内恢复；左侧肿瘤术后，患者血压、心率波动过大，给予可乐定等药物治疗．2周后趋于稳定。其余病例术后经过平稳。结论：术前对大脑侧支循环进行综合评估，合理运用Matas试验，尽量选择单纯瘤体剥除，颈动脉缺损时尽可能即刻行修补或重建，术后采取针对防治脑梗死的措施等．是围术期必须认真对待的问题。

Surgical treatment of carotid body tumor:A clinical analysis of 10 cases

PURPOSE: To summarize our experience of surgical treatment of 10 patients with 11 carotid body tumors. METHODS: In the preoperative period, 9 of 10 cases underwent digital substrate angiography(DSA), among them, 3 cases underwent temporary balloon occlusion(TBO) test and 10 patients underwent Matas test. In the intraoperative period, 9 patients' common carotid arteries were occluded and the patients' general condition was observed firstly under local anesthesia for 30 minutes, then the surgical treatment was carried out under general anesthesia. 5 tumors were peeled off from the carotid arteries simply, 6 tumors were resected with carotid bifurcation, among which 1 internal carotid artery was repaired, 2 internal carotid arteries were reconstructed, 3 common carotid arteries and internal carotid arteries were ligated. The measures of preventing cerebral ischemia or infarction were executed postoperatively. RESULTS: All the patients were followed up for 1-20 years. Hemiplegia occurred in one case with bilateral tumors after first operation on the right side and recovered within one year, also this patient, developed postoperative baroreceptor failure with persistent labile pulse and hypertension after second operation on the left side, clonidine was used and the complication was controlled two weeks later. Other patients had an uneventful postoperative course. CONCLUSION: Preoperative evaluation of intracranial collateral pathways and Matas test, reasonable surgical procedure and postoperative prevention of cerebral infarction were necessary for surgical treatment of carotid body tumors.