颈动脉体瘤的DSA检查方法和价值

目的 探讨颈动脉体瘤术前DSA检查的方法,表现及对手术的指导作用.方法 5例颈动脉体瘤术前接受DSA检查,包括双侧颈总动脉造影,选择性颈内动脉和椎动脉造影,其中4例进行了Matas试验交叉造影.造影后5例患者均手术切除了肿瘤,其中单纯肿瘤分离切除3例,肿瘤切除加颈动脉修补1例,肿瘤连同颈动脉切除1例.结果 5例肿瘤DSA表现典型,包括颈动脉分叉角度增大,血供丰富,肿瘤部分或完全包绕颈动脉.此外1例椎动脉分支参与肿瘤供血,1例出现动-静脉瘘.颈内动脉造影1例患侧大脑前动脉水平段发育不艮.Matas试验2例Willis环代偿艮好,1例经2周训练后Willis环开放,1例因大脑前动脉水平段发育不良,无法建立有效代偿.结论 颈动脉体瘤具有典型的DSA表现,且在肿瘤对血管侵蚀程度的判断、脑血管发育状况和代偿能力、颈动脉阻断后脑耐受性的评估等方面,DSA具有不可替代的作用,可为手术风险的评估和手术方案的制定提供依据.     

颈动脉体瘤的影像学诊断

目的 探讨CT、MRI、DSA检查在颈动脉体瘤诊断中的价值.方法 病理证实的10例颈动脉体瘤,其中4例行MRI T1WI、T2WI及对比增强MRA,6例行CT平扫加增强扫描,10例均行DSA和TBO试验.结果 10例术前CT、MRI、DSA均诊断为颈动脉体瘤,与临床及病理诊断符合率为100%.10例病变均位于颈动脉分叉处.CT平扫主要表现为均匀性低密度球形病灶,CT值25～37 Hu.MRI的特征为T1WI、T2WI均为高信号,中心有流空信号,MRA均清楚显示出病变的部位、大小、形态及血流动力学的特点.DSA表现为肿瘤包绕颈动脉,颈动脉分叉角度增大,肿瘤均匀染色,可显示供血动脉.结论 CT、MRI和DSA均有特征性表现,诊断比较容易,若将三种方法优化组合,可优势互补,为制定最佳手术方案提供科学、准确而全面的依据.     

双源 CT 血管成像在颈动脉体瘤术前评估中的价值

目的：探讨双源CT （DSCT ）血管成像在颈动脉体瘤术前评估中的价值。方法收集18例颈动脉体瘤患者行DSCT头颈部血管造影,通过多方位重建（MPR）、最大密度投影（MIP）和容积再现（VR）得到二维和三维重建图像。所有患者均同时做了彩色多普勒血管显像（CDFI）检查,并均经手术证实。结果 DSCT血管成像均能成功地检查所有患者,18例患者共检出18个颈动脉体瘤,所有患者均为单侧颈动脉体瘤,肿瘤直径最大为12 cm ,最小为1.2 cm ,所有患者的头颈血管、肿瘤的血管生成以及肿瘤与周围血管的关系均得以清楚显示。结论 DSC T血管成像是一种很有价值的可以准确显示颈动脉体瘤患者双侧的头颈血管的诊断手段,能为手术提供可靠的信息。     

Eight cases of carotid body tumor diagnosed by Bmode ultrasonic imaging

This paper reports that 8 patients with carotid body tumors were diag-nosed by B-mode ultrasonic imaging.Among them,only 3 were originally clinicallydiagnosed as having the disease.The features of carotid body tumors in the 8cases,seen by B-mode ultrasonogram,are described.It is considered thatultrasonography of carotid body tumors is specific,trauma-free,accurate andsimple,and it may be an important method in identifying and diagnosing the dis-ease.     

颈动脉体瘤21例临床诊治分析

目的：总结颈动脉体瘤（carotid body tumors,CBT）的诊治经验,探讨CBT的诊断、术前准备、手术方法和并发症的防治。方法：21例CBT患者术前均行B超检查,8例术前行数字减影血管造影检查,13例行多排螺旋CT血管成像或磁共振血管成像检查,21例术前均行颈动脉压迫试验。10例采用单纯瘤体切除,7例行瘤体与颈外动脉切除,4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重建术。结果：21例瘤体均完全切除,术后无死亡、偏瘫和失明病例;发生患侧口角歪斜、霍纳综合征、声音嘶哑、舌歪、饮水呛咳各1例。20例均获随访,时间4个月至15年,无术后复发及转移。结论：术前彩超、选择性血管造影、多排螺旋CT血管成像或磁共振血管成像等检查可以明确诊断,外科手术切除是治疗CBT首选方法,术中减少脑缺血时间和脑神经的保护是预防术后严重并发症的关键。     

16层螺旋CT血管成像在颈动脉体瘤诊断中的价值

目的 探讨16层螺旋CT血管造影（CTA）在颈动脉体瘤诊断和鉴别诊断中的应用价值及技术优势。方法 回顾性分析8例经临床或病理证实的颈动脉体瘤的CTA检查结果及临床资料，并对血管显示情况进行评价。结果（1）常见CT表现：平扫时，8例瘤体肿块均较大，直经约为3～6cm，呈形态不规则、边缘较清楚，无钙化；动脉期肿块呈斑片状明显强化伴有丰富的肿瘤血管影：静脉期肿块呈不均匀强化，强化程度明显高于动脉期，伴有丰富的肿瘤血管影。（2）多平面重建、最大密度投影、容积重建能清楚显示瘤体位于颈内、外动脉分叉处，分又角明显增大，甚至呈圆弧状改变；能清晰显示肿块与周围骨质等邻近结构的关系。结论 16层螺旋CT血管成像是一种无创的颈动脉体瘤的首选诊断方法，能清楚显示瘤体与颈动脉及其邻近结构的关系，具有方便、准确、特异等特点。     

颈动脉体瘤诊断与处理-单中心经验

目的通过单中心颈动脉体瘤患者的临床资料分析,总结颈动脉体瘤的诊断和治疗经验。方法回顾分析17例颈动脉体瘤患者的临床资料,男7例,女10例,年龄平均39岁(25～65),均为单侧病变。结果 Shamblin分型Ⅰ型2例,Ⅱ型8例,Ⅲ型7例。术前影像学评估包括B超、CT、核磁血管成像(magnetic resonance angiography,MRA)以及数字减影血管造影(digitalsubtraction angiography,DSA)。其中16例经手术切除,手术方式包括伴或不伴颈外动脉切除的完整剥离;瘤体连同颈内-颈总动脉切除血管重建;瘤体连同颈总颈内动脉切除断端结扎;颅底颅内受累行颅内外联合入路手术。术后病理检查均为良性。随访43个月(9～108),手术并发症包括单侧喉返神经麻痹6例,其中永久性声带麻痹2例,单侧面瘫1例,单侧舌下神经麻痹2例,出血1例,脑血管意外及死亡发生率为0%。结论 DSA检查是颈动脉体瘤的重要确诊及评估手段之一。术中双极电凝的仔细分离、血管外科器械短暂的供血动脉阻断、血管外科的转流及重建技术对手术的顺利进行,降低术后并发症非常关键。     

颈动脉体瘤的外科治疗

目的:探讨颈动脉体瘤(CBT)的诊断和外科治疗方法.方法:分析我院2001年4月～2003年10月收治的8例CBT的临床资料及手术结果.结果:8例CBT术前均经颈部超声及颈动脉造影术证实;8例均经手术治疗,其中颈外动脉与CBT同时切除1例,其余7例行外膜下剥离切除术.无手术死亡, 术后随访1个月～24个月,无术后颅神经损伤.结论:颈部超声检查是CBT简便有效诊断方法,颈动脉造影术是CBT的诊断和术前评估最有效和重要的手段,手术是CBT的首选和有效的治疗手段.准确的术前评估,正确的手术方法选择和手术顺序是手术成败的关键.     

颈动脉体瘤的CT多平面成像诊断

目的：探讨颈动脉体瘤的CT多平面成像表现。方法：对8例经手术病理证实为颈动脉体瘤的临床资料进行回顾性分析。结果：8个颈动脉体瘤均位于颈动脉分叉水平，术前行CT平扫和高分辨CT增强扫描并行多平面成像（MPR）处理。CT平扫表现为软组织密度肿块，呈圆形或卵圆形，边缘清楚，增强扫描肿瘤明显强化，MPR显示颈动脉分叉扩大，其中2例肿瘤向上侵犯颅底并经颈静脉孔侵入颅后窝桥小脑角区。结论：高分辨CT增强扫描加多平面成像是诊断颈动脉体瘤及其周围侵犯关系的安全、可靠的检查方法之一。     

颈动脉体瘤81例临床分析

目的探讨颈动脉体瘤(CBT)的诊断与治疗方法。方法81例CBT患者,42例采用单纯瘤体切除,24例行瘤体与颈内、外动脉一并切除,未做颈动脉重建;8例瘤体切除,同时行颈内动脉修补;5例行CBT摘除术,并颈内动脉吻合;2例行瘤体与颈内外动脉切除,同时行颈内动脉重建。结果81例术后随诊1～13 a,平均11 a;81例无手术死亡,72例肿瘤完全切除,预后良好;9例大部切除,其中3例死亡(1例死于心脏病,1例死于颅底转移,1例死于肺转移);其余患者最后1次随访均健在。术后发生脑卒中瘫痪1例,5例出现脑神经并发症,舌神经损伤25例。结论CBT应尽早手术治疗,根据肿瘤与颈动脉的关系选择适宜术式。     

Recurrent malignant carotid body tumor: report of one case and review of the literature

Carotid body tumor (CBT) is a rare tumor, which is composed of chromaffin cells, groups of cells associated with the autonomous system, occurring at the carotid bifurcation. This tumor grows slowly, usually with a history of several years and seldom undergoes malignant transformation. The majority of CBT are benign, only few cases of malignant CBTs were reported in the literature.1-3 Over a period of 10 years (1993-2004), 28 patients with CBT were diagnosed and surgically treated in the Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, School of Stomatology, Shanghai Jiaotong University, only one was proven both clinically and histopathologically to be malignant CBT. This paper reports this unusual patient with recurrent malignant carotid body tumor as well as cervical lymph node metastases and reviews the relevant literature.     

Significance of the preoperative guidance of dual-source CT in carotid body tumor

Background Accurate views of the head and neck vessels, tumor angiogenesis and the relationship of tumor and the surrounding blood vessels are especially crucial to carotid body tumor （CBT） patients. The aim of this study was to explore the value of dual-source CT （DSCT） cerebral and carotid angiography in CBT diagnosis.Methods DSCT cerebral and carotid angiography was performed on nine patients with CBT. Two-dimensional and three-dimensional reconstruction images were obtained by means of multiple planar reconstructions （MPR）,maximum intensity projection （MIP） and volume rendering （VR）. All patients were subjected to color Doppler flow imaging （CDFI） examination. Two kinds of examinations were performed in 3 days, and all patients were confirmed by surgery.Results DSCT angiography was successful in all patients. CBTs were diagnosed in 9 patients with 10 lesions （1 case had multiple bilateral CBTs）. The largest lesion was 12 cm in diameter, and the smallest one was 1.6 cm in diameter. All patients had clearly demonstrated head and neck vessels, tumor angiogenesis, and tumor relationship with the surrounding blood vessels. The internal and external carotid artery （ICA, ECA） were involved in 2 cases. There were 7 cases with basilar artery ring integrity, and 1 case had the posterior communicating artery absent; 1 case had middle cerebral artery stenosis; 4 cases （4 tumors） showed arterial phase homogeneous enhancement; 5 cases （6 tumors） had obvious heterogeneous enhancement where irregular low-density necrosis could be seen in the tumors. CDFI could demonstrate the nearby blood vessels and tumor structure, instead of tumor angiogenesis. However, DSCT can display both the tumor and the peripheral vascular tumor angiogenesis consistent with surgical findings.Conclusions DSCT cerebral and carotid angiography can provide reliable information for the operation. It might be a valuable CBT diagnostic method by showing accurate views of the CBT along with the bilateral neck and brain blood vessels.     

数字减影血管造影在耳鼻咽喉科的应用

目的:探讨数字减影血管造影(DSA)在耳鼻咽疾病诊治中的应用前景.方法:回顾性分析我科1995年11月至1999年12月应用DSA诊治严重鼻出血10血咽纤维篾这瘤3例、咽部及咽旁间隙占位性病变各1例的诊断和治疗情况。结果：10例严重鼻出血中9例在DSA下行血管栓塞治疗。8例成功,有效率为88.89%;3例鼻咽纤维血管瘤术前栓塞肿瘤血动脉均获成功,减少了术中出血量;2例占位性病变经DSA得以明确诊断,所有行DSA的患均未发生严重并发症。结论：DSA不仅是诊断和治疗严重鼻出血的安全、有效的方法,且能对占位性病变作鉴别诊断,术前选择性栓塞瘤林供血动脉,能有效地减少术中出血量。     

颈动脉体瘤诊断与处理

目的 探讨颈动脉体瘤（CBT）诊断、手术治疗以及防治术后并发症的经验。方法整理15例CBT患者的病历资料，回顾性分析并加以总结。结果15例按照Shamblin分型，I型2例，Ⅱ型8例，Ⅱ型5例。术前影像学评估包括B超、CT、MRA，以及数字减影血管造影DSA、64排CT增强扫描结合血管成像CTA。行手术切除14例，手术方式包括伴或不伴颈外动脉切除的完整剥离；瘤体连同颈内-颈总动脉切除血管重建。术后病理检查均为良性。所有患者经3个月～9年4个月随访，出现单侧喉返神经麻痹2例，单侧舌下神经麻痹1例，单侧颈交感神经损伤1例，无脑血管意外及死亡，均无局部复发。结论64排CTA可作为CBT术前诊断、评估的首选方法。而正确诊断、周密完善的术前评估及合理的手术方案能减少术后严重并发症。     

数字减影血管造影引导下血管内栓塞联合经皮穿刺硬化治疗体表血管畸形20例

目的:总结数字减影血管造影(DSA)引导下血管内栓塞联合经皮穿刺硬化治疗体表血管畸形的技术方法与疗效。方法:20例经临床表现及相关影像学诊断为体表血管畸形(动脉畸形7例,静脉畸形9例,混合畸形4例),其中动脉畸形7例和混合畸形4例采取血管内平阳霉素+聚乙烯醇颗粒或碘化油等栓塞治疗,静脉畸形9例采取DSA引导下经皮硬化穿刺平阳霉素+无水乙醇硬化,多次序贯治疗,每疗程间隔3周。结果:治愈12例,好转8例。无一例发生局部组织坏死、皮肤破溃等情况。结论:DSA引导下血管内栓塞联合经皮穿刺硬化治疗体表血管畸形操作简便、安全可靠、无瘢痕、创伤小,可有效减少或避免并发症的发生,提高治疗效果,值得临床推广。     

双源CT在颈动脉体瘤术前的指导意义

Objective To explore the value of dual-source CT（DSCT）cerebral and carotid angiography in carotid body tumor (CBT) diagnosis. Methods DSCT cerebral and carotid angiography was performed on nine patients with carotid body tumor. Two-dimensional and three-dimensional reconstruction images were performed by means of multiple planar reconstructions (MPR), maximum intensity projection (MIP) and volume rendering (VR). All patients were subjected to color Doppler flow imaging (CDFI) examination. Two kinds of examinations were performed in 3 days, and all patients were confirmed by surgery. Results All patients were successful in DSCT angiography. Carotid body tumors were diagnosed in 9 patients with 10 lesions as; 1 case had multiple bilateral CBTs. The largest lesion was 12 cm in diameter, and the smallest one was 1.6 cm in diameter. All patients head and neck vessels, tumor angiogenesis, and the tumor relationship with the surrounding blood vessels were demonstrated clearly. Internal and external carotid artery (ICA, ECA) were involved in 2 cases. There were 7 cases with basilar artery ring integrity, and 1 case had the posterior communicating artery absent; 1 case had middle cerebral artery stenosis; 4 cases (4 tumors) showed arterial phase homogeneous enhancement; 5 cases (6 tumors) had obvious heterogeneous enhancement where irregular low-density necrosis could be seen in the tumors. CDFI could demonstrate the tumor and nearby blood vessels, instead of tumor angiogenesis. However, DSCT could display both the tumor and the peripheral vascular tumor angiogenesis consistent with surgical findings. Conclusion DSCT cerebral and carotid angiography might be a valuable carotid body tumor diagnostic method by showing accurate views of the carotid body tumor along with the bilateral neck and brain blood vessels, providing reliable information for the operation.     

多层螺旋CT检查对颈动脉体瘤术中处理的临床价值

目的探讨多层螺旋CT检查对颈动脉体瘤术中处理的指导意义。方法回顾性分析11例病理证实的颈动脉体瘤的CT及CTA结果与术中所见的吻合情况。结果11例中单侧8例，双侧3例，共14个肿块，术前CT显示7侧肿块仅推移颈内、外动脉，术中完成单纯瘤体剥除；7侧颈内动脉完全被肿块包裹，3侧合并管腔不规则狭窄者术中均行血管重建，1侧管腔闭塞者切除肿块及颈动脉分叉，3侧管径正常者行瘤体剥除术，术后恢复良好。CT表现与术中所见基本一致。结论术前多层螺旋CT检查对预测颈动脉体瘤术中风险具有重要指导意义。     

颈动脉体瘤的外科治疗

目的：总结颈动脉体瘤的外科治疗经验。方法：35例36侧颈动脉体瘤行手术治疗。其中颈动脉体瘤单纯剥离20例（21侧），颈动脉体瘤及颈外动脉切除3例，肿瘤及颈内动脉切除颈外替代颈内动脉2例，动脉对端吻合2例，血管移植6例，补片修复1例，动脉结扎1例。手术在全身麻醉下进行，12例采用冰帽头部局部低温。结果：围手术期死亡1例，死亡率2．8％，术后发生霍纳综合征2例，迷走神经、面神经下颌支及喉上神经损伤各1例。29例随访1－25年，全部随访患者没有复发。恶性颈动脉体瘤1例，失访。结论：手术是治疗颈动脉体瘤的最佳方法，延误反使手术增加困难。脑保护是降低手术死亡率和并发症的重要措施，完整的保留或重建颈内动脉是手术成功的重要保证。     

颈动脉体瘤的诊断及外科治疗

目的 探讨颈动脉体瘤的诊断及外科治疗。方法 回顾性分析了1983年1月-2002年6月间我院收治的38例患者的41个颈动脉体瘤的临床资料。结果 38例患者术前均常规行B超及血管造影,诊断符合率分别为95％和98％。手术切除肿瘤38个,其中12例行颈外动脉切断、颈内动脉部分缺损修补、动脉体瘤切除术;11例行颈外动脉切断、动脉体瘤切除术;8例行单纯瘤体切除术;6例行颈外动脉切断、颈内动脉重建术;1例行动脉体瘤切除,颈内、颈外、颈总动脉部分切除术。结论 对于可疑颈动脉体瘤患者,术前应常规行B超及颈部血管影像重建。早期、一次手术切除及术中颈内动脉血供重建是治疗及降低手术并发症的关键。     

颈动脉体瘤的诊断和治疗

目的：探讨颈动脉体瘤诊断和治疗经验。方法：分析1968-2001年收治的46例颈动脉体瘤患者的临床资料。结果：细针穿刺细胞学检查2例,抽出物均为血液;血池扫描检查12例,10例（83%）诊断为颈动脉体瘤;数字减影血管造影检查5例,均诊断为颈动脉体瘤;B超检查15例,14例（93%）诊断为颈动脉体瘤;CT检查7例,5例（71%）诊断为颈动脉体瘤：MRI检查4例,均诊断为颈动脉体瘤,其中MRA2例。46例均行手术治疗,5例接受放射治疗,随诊其中肿瘤无复发。结论:B超足以诊断颈动脉体瘤,MRI/MRA能够为拟订合理的治疗方案提供帮助。手术是治疗颈动脉体瘤首选的治疗措施。术中耐心细致的解剖可以降低术后并发症的发生。