72例颈动脉体瘤的诊断和治疗的回顾性分析

目的 总结颈动脉体瘤诊断、手术治疗以及并发症防治的经验.方法 对我科自1989年2月至2008年2月19年间共收治颈动脉体瘤患者72例(81个)进行回顾性分析.结果 采用血管造影术、彩超以及CTA或MRA明确术前诊断.根据瘤体和颈动脉的关系,81个肿瘤均一期切除,其中行单纯瘤体剥除48例(57个);瘤体连同颈外动脉一同切除5例;瘤体连同部分颈内动脉、颈外动脉,及颈总动脉一并切除后行颈动脉搭桥重建术13例;颈总动脉,颈内动脉吻合2例;颈内动脉结扎术4例.术后15例发生声嘶,8例发生饮水呛咳,经积极治疗后症状消失.3例发生偏瘫,经积极治疗及出院后随访肌力均恢复至两级以上.经5个月至4年随访,8例失访,3例复发,其余无一例手术死亡及其他并发症的发生.结论 术前选择性血管造影、CTA或MRA等检查以明确诊断,应尽早手术治疗,根据肿瘤与颈动脉的关系选择适宜术式.手术中脑神经的保护和减少脑缺血时间是预防术后严重并发症的关键.     

颈动脉体瘤外科治疗并发症的分析

目的：总结46例颈动脉体瘤手术治疗结果以及并发症防治的经验。方法;对采用肿瘤剥除术,同时切除颈外动脉术,与颈动脉分叉－并切除后血管重建术以及颈总动脉结扎术等方法治疗的颈动脉体瘤手术效果和并发症进行回顾性分析。结果：手术切除率91．3％,偏瘫2例,舌下神经损伤4例,舌咽神经损伤2例,迷走神经损伤1例,副神经损伤1例,其中1例同时有舌咽,迷走,舌下神经损伤。长期随访复发2例,再次手术切除。所有病例无手术死亡。结论：术前选择性血管造影,田径赛眼声多普勒等检查以明确诊断,合理的Matas训练以及选择适当的术式,对于颈动脉体瘤外科治疗和减少并发症是必要的。     

颈动脉体瘤22例临床分析

目的：探讨合理的颈动脉体瘤临床治疗方案。方法：回顾22例颈动脉体瘤临床资料，分析手术方式与并发症的关系，并对存活病例进行随访观察。结果：手术后近期21例存活，1例死亡为颈动脉结扎手术引起急性脑缺血所致。21例中发生面神经损伤、迷走神经损伤各1例。6月-10年随访，平均4年5个月，1例术后5年复发，1例术后3年因其它疾病死亡。结论：肿瘤单纯切除和肿瘤切除、颈动脉重建是安全、有效的治疗方案，手术中脑神经的保护和减少脑缺血时间是预防术后严重并发症的关键。     

颈动脉体瘤的诊疗体会

目的探讨颈动脉体瘤(CBT)的有效诊治方案。方法回顾性分析2008年6月～2011年9月我院收治的6例CBT患者的临床资料。患者术前均联合行颈动脉CT血管造影、颈动脉数字减影血管造影和彩色多普勒超声检查明确诊断。经过2周以上Matas训练。结果 6例均接受手术并完整切除肿瘤,其中2例因肿物大,颈内动脉末端难以显露,需行下颌骨旁正中劈开术显露。无病例死亡,无严重手术并发症。随访0.5～5年无复发病例。结论充分的术前检查及准备、合理的手术方法能提高CBT手术的成功率。     

27例颈动脉体瘤的外科诊疗分析

目的总结颈动脉体瘤的诊断、治疗及预防术后并发症的体会。方法回顾性分析笔者所在医院科室于2005年6月至2016年6月期间收治的27例(30个瘤体)颈动脉体瘤患者的临床资料。结果 27例患者中,24例为单侧病变,3例为双侧病变,共计30个瘤体。术前3例行彩超检查,18例行电子计算机断层血管造影(CTA)检查,3例行磁共振血管造影(MRA)检查,6例行数字减影(DSA)检查。Shamblin分型:Ⅰ型10个,Ⅱ型16个,Ⅲ型4个。20个瘤体行单纯瘤体剥离术,6个瘤体行瘤体切除+颈外动脉切除,2个瘤体行瘤体切除+颈内动脉部分切除+颈外-颈内动脉吻合术,2个瘤体行瘤体切除+颈内动脉、颈外动脉及颈总动脉部分切除+颈内-颈总动脉搭桥术。手术均顺利,无一例患者死亡。术后发生偏瘫1例,声嘶2例,饮水呛咳1例。本组27例患者中获访24例,随访时间为3个月~4年,中位数为2.3年。随访过程中,1例偏瘫患者经康复治疗后于术后6个月肌力恢复至3级以上,2例声嘶及1例饮水呛咳患者经对症治疗后于术后2个月恢复正常。24例获访患者随访期间均未复发,无其他并发症发生。结论 CTA和MRA检查有助于颈动脉体瘤的明确诊断,确诊后应积极行手术治疗。     

颈动脉体瘤诊治的临床分析：附38例报告

目的：总结颈动脉体瘤（CBT）的临床特征与诊治经验。 方法：回顾性分析2008年10月—2019年4月在中南大学湘雅医院血管外科治疗的38例CBT患者资料,其中男14例,女24例;年龄23~76岁;单侧36例,双侧2例;40个瘤体中,Shamblin I型6个、II型12个、III型22个。 结果：所有患者均行颈部CTA或MRA明确诊断。38例患者中,3例单侧患者行保守治疗,其余35例患者共37个瘤体行手术切除治疗,其中1例手术患者术前行DSA检查并行双侧颈外动脉栓塞术。无术中死亡病例,手术平均时间（140±48）min,术中平均出血量（194±148）mL;Shamblin I型病变均行单纯CBT切除,Shamblin II、III型病变行单纯CBT切除或CBT切除+其他手术（颈部动脉离断、重建、结扎）。所有手术患者术后病理检查均证实为颈部良性副神经节瘤。术后发生短暂脑神经损伤8例,永久脑神经损伤2例,死亡1例。单纯CBT切除患者的神经损伤发生率明显低于CBT切除联合其他手术患者（P<0.05）。随访半月至10年,手术患者未出现肿瘤复发及其他并发症。3例保守治疗患者均带瘤生存。 结论：CTA或MRA为诊断CBT的首选方法,手术切除是CBT的首选治疗方法。手术方式的选择还需根据瘤体的大小形态以及分型决定。     

术中颈内动脉转流在颈动脉体瘤切除中的应用

目的 总结颈动脉体瘤(carotid body tumor,CBT)的临床特点,诊断和外科治疗体会,以及术中颈内动脉转流在切除复杂颈动脉体瘤中的应用及效果.方法 回顾性分析1991年1月至2008年12月30例颈动脉体瘤的外科治疗,其中4例患者采用术中颈内动脉转流的临床资料.患者平均年龄(39.2±2.3)岁,男10例,女20例.左侧15例,右侧14例,双侧1例,平均直径(4.9±0.3)cm.术前经彩超、CT、MRI、CTA等明确诊断.手术方式采用单纯颈动脉体瘤切除16例,颈动脉体瘤切除加颈外动脉结扎10例,颈动脉体瘤切除加术中颈内动脉转流自体大隐静脉血管重建4例.结果 30例手术顺利成功,术后经病理检查结果证实均为颈动脉体瘤,4例患者存在血管壁包膜侵犯.术后并发症:声嘶15例,呛咳11例,舌歪17例,面部麻木2例,呼吸困难1例,吞咽困难3例.4例术中行颈内动脉转流下顺利切除瘤体,术后无脑梗塞.全部病例术后无死亡.结论 颈动脉体瘤首选的治疗方式是外科切除.复杂Shamblin Ⅲ型CBT术中必要时采用颈内动脉转流下切除瘤体是一种安全,有效的治疗手段.     

颈动脉体瘤15例的外科诊治体会

目的探讨颈动脉体瘤的诊断和手术治疗经验。方法回顾性分析1999年9月至2009年12月收治的15例颈动脉体瘤患者的临床资料。9例采用瘤体剥离术,6例行瘤体与所包裹的血管一并切除,切除后因血管长度不够,行血管间置,移植血管替代物中4例选用大隐静脉、1例选用颈外静脉、1例选用人工血管。结果15例术后病理证实为颈动脉体瘤,术后无死亡和偏瘫发生。舌下神经损伤1例,迷走神经损伤2例。结论颈动脉体瘤因为解剖上的特殊性,手术是治疗颈动脉体瘤首选的治疗措施。手术方式的选择应该根据肿瘤与动脉的密切关系来决定。     

颈动脉体瘤的手术治疗及并发症分析体会

目的 分析总结手术治疗颈动脉体瘤及术后并发症防治方面的经验体会.方法 回顾性分析1996年8月-2016年6月在新疆维吾尔自治区人民医院血管外科诊治的45例颈动脉体瘤患者的病例资料,以上患者术后随访18个月,随访均在新疆维吾尔自治区人民医院血管外科住院或门诊复查形式进行,随访期间主要观察患者术后出现的并发症及恢复情况,术前2周均进行颈动脉压迫试验(Matas试验).其中男性20例(颈动脉体瘤病变位于双侧者为4例,颈动脉体瘤病变位于单侧者为16例),女性25例(颈动脉体瘤病变位于双侧者为1例,颈动脉体瘤病变位于单侧者为24例);病程0.5～6.0年,平均3年.分析术后并发症发生情况.结果 手术均成功,无围手术期死亡病例,手术治疗的45例患者中采用一种或一种以上手术方式,其中30例患者获得随访,其余15例患者失访,平均随访18个月,出现并发症包括:脑卒中1例,舌下神经损伤8例,迷走神经损伤13例,Homer综合征9例.随访患者均无复发,6个月内神经损伤症状基本恢复,1例行迷走神经与瘤体并切者随访6个月后,仍有吞咽困难和声音嘶哑.5例双侧病变者,其中3例行双侧分期切除手术,手术顺利.1例单侧切除术后出现迷走神经损伤,故未行对侧手术;1例一侧手术后失访,对侧未接受手术.结论 术后出现声音嘶哑并非喉返神经损伤所致,双侧颈动脉病变先切除小的一侧,Matas试验不能作为术中结扎颈内动脉的依据.     

颈动脉体瘤的诊断与外科治疗

目的 总结颈动脉体瘤的诊断与外科治疗经验.方法 回顾性分析42例(46侧)颈动脉体瘤的治疗情况,包括术前准备、麻醉方法、手术方式、手术效果及并发症发生情况.结果 18例(19侧)患者行颈动脉体瘤剥离术,24例(27侧)行颈动脉体瘤切除+颈动脉重建术.围术期无死亡病例,1例患者发生脑梗塞,10例出现颅神经麻痹表现.随访期间未发现肿瘤复发.结论 手术是颈动脉体瘤的首选治疗,完整地保留或重建颈动脉是手术的关键.     

颈动脉体瘤的外科治疗

目的 探讨颈动脉体瘤的诊断与外科治疗.方法 分析山东大学附属省立医院血管外科2003年1月至2010年10月收治16例颈动脉体瘤患者,经数字减影血管造影术检查得以最终确诊.采用Shamblin分型标准分型:Ⅰ型3例,Ⅱ型11例,Ⅲ型2例,本组全部行外科手术治疗.3例ⅠⅠ型患者行单纯摘除术.11例Ⅱ型患者中,3例行单纯摘除术,3例行摘除术并颈外动脉切除,3例行摘除术、颈外动脉切除并颈动脉修补术,2例行摘除术、颈外动脉切除并颈内动脉重建术.2例Ⅲ型患者,1例行摘除术、颈外动脉切除并颈动脉修补术,1例行摘除术、颈外动脉切除并颈内动脉重建术.结果 16例患者病理均证实为颈动脉体瘤.无手术死亡、偏瘫和失明.术后并发症中以颅神经损伤最多见,共有7例(43.75%),经对症治疗,6例有不同程度改善,1例遗留永久性13角歪斜.随访13例(81.25%),随访时间2～76个月,平均(42.0±1.2)个月,未见肿瘤复发和远处转移.结论 数字减影血管造影术在颈动脉体瘤的诊断和治疗中具有重要意义,颈动脉体瘤应首选手术治疗,可根据瘤体与血管的关系选择适当的术式.

Abstract：

Objective To discuss the diagnosis and surgical treatment for carotid body tumors (CBT). Methods Retrospective analysis was made on 16 cases of carotid body tumors hospitalized in Shandong Provincal Hospital from January 2003 to October 2010. All patients were diagnosed by digital subtraction angiography, including 3 case of Shamblin type Ⅰ,11 cases of Shamblin type Ⅱ and 2 cases of Shamblin type Ⅲ. Three cases of type Ⅰ and 3 cases of type Ⅱ underwent carotid body tumor resection. Three cases of type Ⅱ underwent carotid body tumor plus external carotid artery resection, 3 cases underwent carotid body tumor plus external carotid artery resection plus carotid artery repairment, 2 cases did carotid body tumor plus external carotid artery resection plus internal carotid artery reconstruction. One of type Ⅲ underwent carotid body tumor plus external carotid artery resection plus carotid artery repairment, and the other one underwent carotid body tumor plus external carotid artery resection plus internal carotid artery reconstruction. Results Diagnosis of CBT was confirmed by pathology in all cases. There was no postoperative death、hemiplegia and blindness. The cranial nerve injury was caused in 7 cases, accounting for 43. 75%. 13 cases ( 81. 25% ) were followed up for 2 to 76 months ( mean 42 months), no tumor recurrence and metastasis was found. Conclusions Digital subtraction angiography (DSA) is important in the diagnosis and therapy of carotid body tumor. Surgical treatment is the choice of therapy for carotid body tumors.     

颈动脉体瘤81例诊断与手术治疗

目的 探讨颈动脉体瘤的诊断和手术治疗.方法 回顾性分析第四军医大学西京医院甲乳血管外科2008年11月-2015年11月收治的81例颈动脉体瘤患者的临床资料.采用SPSS19.0统计学软件对资料进行分析,总结颈动脉体瘤的诊断、手术方式选择、疗效及并发症防治措施.结果 74例进行了手术治疗,其中瘤体单纯剥离52例,瘤体切除联合颈外动脉结扎13例,瘤体切除连同颈内动脉和颈外动脉结扎7例,其中3例行人工血管颈内动脉端端吻合.术后死于急性心肌梗死1例,并发脑梗死2例,颅神经损伤6例,对症处理后缓解出院.无偏瘫、失语等严重并发症.瘤体大小和手术时间相关性分析:相关系数为0.226,无明显相关性.结论 CTA是最常用的术前检查方法.手术切除是治疗颈动脉体瘤的有效方法.保留或重建颈内动脉是手术成功的关键.术前充分评估,选择恰当术式,术中精细操作,保证脑灌注,是预防和减少并发症的关键.     

Carotid body tumors

We present our approach to the management of patients with carotid body tumors, emphasizing the role of magnetic resonance angiography for the identification of these tumors. Medical records of all patients with carotid body tumors who were managed between 1991 and 2001 were retrospectively reviewed. Nine patients with carotid body tumors were identified. There were four males and five females, ranging in age from 28 to 74 years. Duplux scanning, computed tomography (CT) scanning, and angiography were performed for seven patients, whereas Duplux and magnetic resonance angiography were performed for the remaining two patients. Eight patients underwent successful excision of the tumor. Neither postoperative deaths nor strokes occurred. Temporary cranial nerve injury occurred in two patients. One patient developed local recurrence 5 years later. Early diagnosis of carotid body tumors with Duplex and magnetic resonance angiography is possible. Early surgery for carotid body tumors minimizes the risk of complications associated with large tumors.     

Modalities of preoperative imaging of the internal carotid artery used in France

A survey of the 382 members of the Société de Chirurgie Vasculaire de Langue Fran?aise was conducted to determine preferred imaging techniques for preoperative assessment of the proximal internal carotid artery. A total of 180 questionnaires were returned concerning 9390 carotid stenoses treated in the year 2000. Doppler ultrasound (DUS), angiography, magnetic resonance angiography (MRA), and computed tomography angiography (CTA) were routinely used in 99%, 51.5%, 4%, and 3% of cases. Usual work-up methods involved DUS and angiography in 64% of cases, DUS and MRA in 7%, and DUS and CTA in 4% of cases. Indications for endarterectomy were based on DUS and angiography findings in 69% of cases, on DUS and MRA findings in 14%, on DUS and CTA findings in 9%, and on DUS findings alone in 8%. In-house access to CTA or MRA was more frequent at state-run institutions (p = 0.00001). Indication of endarterectomy based on DUS and MRA was more common at institutions equipped with technical facilities for MRA (21% vs. 8%; p = 0.001). An inverse correlation was observed between the number of carotid artery procedures performed and use of DUS and angiography work-up. The number of carotid endarterectomies without angiography is increasing in France. Preoperative DUS is still routinely used. Combined DUS and MRA is the preferred work-up for endarterectomy without angiography. Lack of access to MRA is still a limiting factor. Further study will be needed to evaluate the benefits and risks of endarterectomy without angiography.     

Diagnostic value of CTA and MRA in intracranial traumatic aneurysms

Objective： To investigate the diagnostic value of computerized tomographic angiography （ CTA ） and magnetic resonance angiography （ MRA ） for intracranial traumatic aneurysms （TAs）. Methods： CTA and MRA of six patients with intracranial TAs verified by digital subtraction angiography （DSA） and surgery were retrospectively analysed. All patients were examined by nonenhanced computerized tomography （CT） and two by CTA. The source data were reconstructed by volume rendering （VR） and multi-planar reconstruction （MPR） from CTA. Four of them had maxhnum intensity project （MIP） from MRA. Results ： Of the six patients, a total of seven TAs were detected by CTA and MRA examinations. Five cases had only one TA and one case had two TAs. The average diameter was 2.3 cm （1.1-3.3 cm）. CTA demonstrated two TAs appeared at the cavernous segment of the internal carotid artery （ICA） and the middle cerebral artery （MCA） respectively. MCA TA was definitely and dearly demonstrated on VR images, whereas VR images failed to depict the cavernous ICA TA, which was detected on MPR images. Two TAs were found irregular saccular shape,irregular margin of parent artery and wide neck on CTA. Four MRA examinations demonstrated five TAs, including the cavernous segment ICA TAs （2 cases）, the supraclinoid segment ICA TA （1 case ）, and the cavernous segment associated with opposite side of the petrosal segment ICA TA （1 case）. In a cavernous ICA TA, MRA only revealed aneurysm body, whereas aneurysm neck and distal segment of the parent artery were not revealed. In the remaining cases, MRA clearly depicted aneurysm body and parent artery, whereas the neck was not displayed. ICA TAs showed irregular capsnle-like high signal intensity on MRA images. Four TAs exhibited irregular distal segment of the parent artery. TAs at the supraclinoid segment or MCA failed to find fracture signs on nonenhanced CT. Conclusions： Both CTA and MRA examinations are the effective non-invasive method of imageology for diagnosing intracranlal TAs, while CTA is more eligible for diagnosing TAs after nonenhanced CT has demonstrated skull base fractures.     

Preoperative imaging diagnosis of carotid body tumors

Carotid body tumors (CBTs) are relatively frequent lesions encountered at high altitudes, such in as the Andean Mountains. A correct preoperative diagnosis is essential for surgical planning and performance. For this reason, we have reviewed the evolution of our experience in the imaging diagnosis of these tumors. Between 1980 and June 2008, 160 CBTs were diagnosed. A total of 138 tumors were operated on, 4 are waiting for surgery, and 18 were not operated on because of age, medical conditions, or patient refusal. We have reviewed retrospectively the modalities of imaging diagnosis in our patients who underwent operation. Among the 138 tumors operated on, a correct preoperative diagnosis was done in 127 cases (92%). The preoperative diagnosis of the remaining 11 patients was unspecified benign tumor for 6 patients and neck lymph node for 5 patients. The imaging methods performed by different radiologists were conventional ultrasound, color Doppler ultrasound, carotid conventional angiography (CA), axial tomography, magnetic resonance and magnetic resonance angiography, and computed tomographic angiography (CTA). Most patients had more than one image study. Review of radiologist reports revealed a correct diagnosis in all carotid CA, magnetic resonance studies, and CTA. Additionally, CTA appeared to be a valuable method to predict the Shamblin group. Clinical suspicion and current image techniques permit a correct diagnosis in practically all cases of CBT.     

Carotid body tumour: 30 years experience

Thirty-two patients with 37 carotid body tumours, seen in the Vascular Unit at the Royal Victoria Infirmary, Newcastle upon Tyne between 1956 and 1985 are reviewed. Twenty-six of the tumours were treated by surgical excision. There were no peri- or postoperative deaths, but one patient developed a permanent hemiplegia following surgery (3.8 per cent); cranial nerve palsy occurred in five patients (19.2 per cent). There were no malignant tumours although in one patient, histology of the resected specimen showed the presence of local lymph node invasion (3.8 per cent). In the 7 patients who did not undergo surgery, 3 have been lost to follow-up; the remainder have not shown any significant increase in the size of the tumour. One patient was treated by radiotherapy. It is concluded that surgical excision is the treatment of choice, though observation may be preferred for the older patient with a symptomless, slow-growing tumour. To help reduce the risk of hemiplegia (the most serious complication of surgery) a meticulous surgical technique is necessary and heparin, intraluminal shunting and facilities for arterial repair and grafting must be at hand.     

Spontaneous early recanalization of an acute symptomatic critical stenosis of the extracranial internal carotid artery: a case report

We present a 63-year-old female with critical stenosis of the extracranial portion of the internal carotid artery (ICA), diagnosed using color-coded Duplex ultrasonography (CCDU) and magnetic resonance imaging. Nine days later, the patient showed profound clinical improvement, at which time spontaneous recanalization of the previously highly stenosed ICA was seen in follow-up CCDU and magnetic resonance angiography (MRA) and confirmed by three-dimensional computed tomography angiography (CTA). The detection of recanalization is important in predicting the patient's prognosis and deciding a suboptimal secondary prophylaxis strategy of medical or surgical treatment. Therefore, we suggest performing imaging studies immediately in patients, especially potential surgical or stenting candidates showing great changes in neurological function, through examination with CCDU and confirmation with MRA or CTA, all safe and minimally invasive methods, to see whether recanalization has occurred.