恶性颈动脉体瘤临床治疗及病理分析

目的 探讨恶性颈动脉体瘤的临床特征、病理及预后特点,以及诊断和治疗方法.方法 回顾性总结分析天津医科大学附属肿瘤医院1982年2月至2006年6月50年间收治的9例恶性颈动脉体瘤患者的临床及病理资料.9例均行超声检查,再行数字减影血管造影检查4例,磁共振血管造影检查3例.术前动脉压迫锻炼5例,其余4例肿物较小可触及颈动脉走行者未行压迫锻炼.术式均为动脉体瘤及周围组织扩大切除术,3例阻断颈总动脉,其中1例行人工血管颈动脉重建术,2例结扎颈总动脉.结果 术前诊断"颈动脉体瘤"7例,"转移癌"1例,"颈部肿物待查"1例.8例术后出现颅神经功能障碍,声嘶3例次,舌偏4例次,Horner综合征3例次,口角左偏1例次,呛咳1例次;术中出血50～1800 ml,输血800～1600 ml,无输血并发症;结扎颈动脉者无围手术期死亡及偏瘫等.术后临床及病理诊断恶性颈动脉体瘤9例,有包膜2例,无包膜7例.颈淋巴转移伴肺转移1例.术后放疗2例.随访时间6个月至14年,中位随访时间6年.生存6例,其中伴有间断头晕及呛咳2例;2例死亡,1例死于颈部复发,1例死于肺癌;1例失访.结论 恶性颈动脉体瘤临床少见,常侵犯颈动脉及颅神经,诊断应以病理学特点结合邻近组织侵犯及发生淋巴或远处转移为准;应及早选择手术治疗行广泛切除,发生转移或复发者预后较差,以放疗为主的综合治疗可能有效.

Clinical and pathological analysis of malignant carotid body tumor

Objective To summarize the clinical, pathological and prognosis character of malignant carotid body tumor and explore its methods of diagnosis and treatment. Methods The data of clinic, pathology, treatment and follow-up of nine patients with malignant carotid body tumor in Tianjin Cancer Hospital from February 1982 to June 2006 were analyzed retrospectively. Results Four Male and five female cases were included ,their average history was 6. 5 years. Shamblin classification: one case was type Ⅱ, eight cases were type Ⅲ. All the patients were underwent ultrasonic inspection, four digital subtraction arteriography (DSA) and three magnetic resonance angiography (MRA). Seven cases were diagnosed as carotid body tumor. Five cases underwent Mat as test training course. All the patients were performed wide excision of tumor and surrounding tissue. Three carotids were occludes, one of them reconstructed with vascular prosthesis, two were resected. There were no perioperative hemiplegias or deaths. Before operation, one case had atrophy of left side of tongue and fixed left vocal card; two cases had Homer syndrome. After operation, eight cases had 13 cranial nerve deficits, they were : two cerchnus, four glossal deviation, three Homer syndrome and one drop of oral corner, one chocking cough. Pathologic diagnosis included nine malignant carotid body tumors, two with capsule, seven without capsule, one cervical and one lung metastasis. Two of them underwent radiotherapy. The median follow-up was 6 years (range: 6 months-14 years). Six patients survived. Two cases died, one died of cervical recurrence, the other of lung cancer. One case was lost. Conclusions Malignant carotid body tumor is rare in clinic, and often invade the carotid and cranial nerve, the diagnosis of malignant tumor should base on occurring extensive invasion of adjacent organs and metastasis; Wide surgical excision should be selected early, radiotherapy is effective, the effect of chemotherapy is uncertainty.