颈动脉体瘤诊断与外科治疗的探讨(附30例报告)

目的 :探讨进一步提高颈动脉体瘤诊断符合率和手术成功率的手段。方法 :采用血管造影术 (或数字减影血管造影术 ,即 DSA)明确术前诊断。 3 0例颈动脉体瘤中 ,行血管外膜下剥离 12例 ,外膜下剥离并颈外动脉切除 8例 ,肿瘤并颈内、外动脉切除 10例。结果 :4例失访 ,1例术后 2年死于交通意外 ,2 5例随诊 5个月～ 10年未见肿瘤复发 ,无一例手术死亡或脑血管并发症。结论 :DSA是颈动脉体瘤最具权威性的诊断方法 ,DSA或 (和 )经颅多普勒在颈动脉切除术中起决定性作用 ,准确的术前评估、正确地选择术式和操作步骤是手术成功的关键。

Diagnosis and surgical treatment of carotid body tumor

Objective:To promote the rate of diagnosis and successful rate of operation for carotid body tumor.Method:26 cases of the 30 patients with carotid body tumor were performed by DSA and 5 cases of them, feeding arteries of tumor were embolized with gelfoam through superelective catheterization, preoperativelly. The tumor was resected under carotid adventitial plane in 12 cases, with extracervical artery in 8 cases and with tumor carotid segment block in 10 cases.Result:Of the 30 cases, no one died from operation or cerebral vascular complications. DSA plays a significant role in diagnosis of the tumor. Intraoperative bleeding can be remarkably reduced if feeding arteries were embolized preoperativelly. The tumor fixed to segment of the carotid arteries block was resected and the reconstruction of vasculature was unnecessary as soon as candidates were certified to be qualified by carotid training and DSA or/and TCD tests. Follow up of these 30 patients revealed that 25 of them survived free from cerebrovascular complications and tumor recurrence for 5 months-10 years. 1 of them died from traffic accident 2 year after operation, 4 of them had lost communication.Conclusion:DSA is a most authritative approach for diagnosis of carotid body tumor, DSA and TCD tests play a key role to resect carotid artery without reconstruction. Successful operation based on a precise preoperative evaluation, choice of operative ways and proper procedure.