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。

Surgical treatment of carotid body tumor:Report of 14 consecutive cases

PURPOSE: To investigate preoperative preparation, surgical treatment and prevention of complications of carotid body tumor based on 14 consecutive cases between 1995 and 2003 at the Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, School of Stomatology, Shanghai Second Medical University. METHODS: 13 of 14 patients with carotid body tumor underwent DSA (digital substrate angiography),among which 11 cases underwent TBO (temporary balloon occlusion) test and 1 patient underwent color Doppler inspection preoperatively. 14 cases were surgically treated with different kinds of procedures. 2 cases underwent simple peeling off of the tumors from the carotid artery; 3 cases underwent resection of both the tumor and the external carotid artery; 3 cases underwent resection of both the internal and external carotid artery and the tumor without carotid reconstruction; 3 cases underwent resection of the tumor and repair of the internal carotid artery; and 3 cases underwent resection of the internal, external carotid artery and the tumor with reconstruction of the internal carotid artery. In 1 case with malignant carotid body tumor and invasion of the cranial base, intra- and extra- cranial bypass was performed. RESULTS: All the patients were followed up for 1-9 years. No operative mortality was observed. One patient without carotid reconstruction couldn't calculate, another got hemiplegia one week after resection of the carotid body tumor and carotid artery. Both recovered within 6 months. No recurrence was found during the follow-up. CONCLUSION: Simple peeling off of the tumor from the carotid artery should be the treatment of choice for patients in the primary carotid body tumor surgery. For patients with malignant carotid body tumor or in the secondary operation, carotid reconstruction should be adopted to minimize intra and postoperative complications. Intra- and extra- cranial bypass is considered when necessary. Supported by Research Fund of the Ministry of Public Health (Grant No.96-1-340) and Sustentation Plan for Excellent Academic Leader of Shanghai Municipality (Grant No.96XD14013)