头颈癌累及颈动脉的切除与重建

目的:寻求一种对晚期头颈部恶性肿瘤累及颈动脉患者的外科治疗方法。方法:对4 例头颈部恶性肿瘤(舌癌、食道癌、喉癌、腮腺癌各1 例) 累及颈动脉患者,术前采用TCD、DSA、SPECT等检查脑血管耐受性,术中翻瓣解剖颈内动脉近颅端,用圆钻磨去1cm岩骨段(C5 ) ,使颈内动脉近颅端充分暴露。然后用Shunt 管行颈总-颈内动脉分流,切除肿瘤及颈动脉,同时行颈动脉重建(大隐静脉1 例,人造血管3 例) 胸大肌肌皮瓣修复创面(3 例) 。结果:术后2 周～6 月行B 超、TCD 等检查显示重建颈动脉通畅。4 例患者除1 例出现Honer′s 综合征外均无脑神经症状和并发症。结论:该术式为头颈癌累及颈动脉患者的一种新的治疗方法。

Application of Carotid Artery Reconstruction in Head Neck Malignancy

Objective:The purpose of this study was to establish an ideal operation method to deal with head and neck carcinomas of late stage and involving the carotid.Methods: A total of four metastasized head neck carcinomas involving the carotid arteries were included in this clinical trail. The primary tumors of the four cases tumors were carcinomas of tongue, esophagus, laryngeal and parotid glands. All four cases were examined by means of TCD, DSA, SPECT to confirm good compatibility of brain blood circulation before operations. The bony petrous sections of carotid arteries were drawn off after the exposure of the bone tissue for exterior skull. A by_pass was set up by inserting a shunt tube between the common carotid and the infernal carotid artery. The extended tumor resection was carried out involving the resection of the carotid artery. The artery was reconstructed with saphena magna vein transplantation in one case, and replaced by artificial vessels in two cases. Tissue defects were repaired by pedicle PMMF.Results: The B_typed ultrasound and TCD examination two weeks to six months post_operatively showed the four cases revealed good condition of transplanted carotid arteries, except one case occurred Honer's syndrome, but there was no central nerve's symptom or complication in the other three cases.Conclusion:This operation method could provide a good chance of survival by curettage of later staged head neck tumors. The authors recommend reconstruction of carotid artery in the operation treatment of malignant head neck carcinomas during late stages.