肿瘤累及颈动脉的外科治疗

目的 探讨颈部肿瘤累及大血管的手术中血管处理方法及注意事项.方法 分析8例颈部肿瘤累及颈动脉患者一期整块切除肿瘤及颈动脉以及颈动脉重建手术的方法、效果和术后并发症.结果 患者均在颈动脉转流(颈总动脉-颈内动脉)下切断颈总动脉及颈内动脉,行颈部清扫手术或肿瘤切除术.2例患者采用膨体聚四氟乙烯(expanded polytetrafluoroethylene,ePTFE)人造血管移植,6例患者采用自体大隐静脉移植.全组患者无缺血性脑卒中发生.2例患者术后发生伤口感染,再次手术探查发现均有咽瘘发生.结论 采用术中转流、肿瘤连同受累颈动脉整块切除、颈动脉重建的方法治疗累及颈动脉的颈部进展期肿瘤安全有效并可明显改善患者生活质量.移植血管首选自体静脉.应特别注意防止术后感染.对于手术后局部组织广泛切除,移植血管床无软组织填充、血液供应及侧支循环差或已经暴露咽腔者,应采用转移肌皮瓣覆盖.

Surgical management of advanced neck neoplasm with carotid artery involvement

OBJECTIVE To discuss the surgical management of advanced neck neoplasm with carotid artery involved. METHODS Eight patients with advanced neck carcinoma or Shamblin III carotid body tumor were studied. The carotid arteries of the patients were involved by the tumors. En bloc tumor and invaded carotid artery resections and replacement of the internal carotid artery with graft were performed in all cases. RESULTS All patients had their internal carotid artery removed with radical tumor resections and replaced with polytetrafluoroethylene (PTFE) grafts (2/8) or reconstructed with greater saphenous veins (6/8) under carotid shunt. No ischemic stroke happened. Wounds infection and pharyngeal fistulas happened in 2 patients. CONCLUSION The results suggested that en bloc tumor and invaded carotid artery resection and replacement of the internal carotid artery with graft under shunt is safe and can improve the quality of life of the patients. Autologous vein is the first choice for the graft. Postoperative infectious complications should be prevented, especially in the presence of intraoperative tracheopharynegal contamination. Concomitant myocutaneous flaps should be rotated over the carotid bypass, mass tissue defect areas or opened pharyngeal cavity.