颈动脉体瘤的诊断和治疗

颈动脉体瘤临床上虽少见．但在颈部肿瘤的鉴别诊断上必须列为一项内容，警惕手术前误诊和避免手术中临时处理困难．本文对我院１５年（１９７６～１９９２）９例颈动脉体瘤的诊断治疗进行了回顾性分析，其中４例院外和院内误诊，经手术探查得出正确诊断．术前超声学检查与选择性颈动脉造影能明确诊断．５例施行手术治疗者术前均采用手了法颈动脉压迫训练，促使大脑侧支循环的建立。３例行颈动脉外膜下肿瘤完全切除术，近远期疗效满意．２例切断拮扎颈总动脉，１例再结扎颈内、外动脉，肿瘤切除术；１例再结扎切断动脉分歧部，颈内、外动脉远心端端一端吻合，切除肿瘤．前者术后顺利恢复，无永久性后遗症；后者术后１４天合并患侧侧脑室体旁脑梗塞，遗留有健侧轻度偏瘫，２年后随访恢复较好．作者认为术前超声检查与选择性颈动脉造影对确定诊断与颈动脉压迫锻炼准确建立大脑侧支循环是对一部分必须切除颈动脉分歧部的颈动脉体瘤手术成功的关键．

Diagnosis and Treatment of Carotid Body Tumor

Carotid body tumors are rare although they must be born in mind for the Differential diagnosis of a neck mass.The records of 9 patients with carotid body trmors diagnosed and treated in the department from 1976 to 1992 were retrospectively reviewed.Preoperative misdiagnosiswas made in 4 cases until exploratory operation' Doppler sonography and selective carotid arteriography can establish definitive diagnosis.Operations were performed on 5 pariens after collateralcerebral circulation proved to be established. Carotid body tumor was completely extirpated in 3batients with good result.Carotid body tumor and carotid bifurcation were resected in other 2 patients without reconstruction of internal carotid artery.Of which,one patient recovered uneventfully without persistent sequelae,infarct in the vinicity of lateral cerebral ventricle complicated inanother patient in 14th day after operation' Regarding the exact operative regimen,we suggestpreoperative temporary carotid occlusion promoting effective establishment of collateral cerebralcirculation is paramount importance whenever tumor with carotid bifurcation is necessary.