具有内分泌活性的颈动脉体瘤的临床病理特征及其外科治疗

目的分析颈动脉体瘤(carotid body tumor,CBT)的内分泌活性、病理特征,总结颈动脉体瘤外科治疗及围手术期体会。方法回顾分析1991年1月至2011年8月我科颈动脉体瘤患者中7例有内分泌活性患者的外科治疗。7例患者经围手术期进行周密的准备,术前纠正血钾,术中稳定血压,并采用术中转流等方法切除瘤体。术后监测血压、血钾变化情况。术后病理活检,行HE染色及免疫组化嗜铬蛋白(CgA)、支持细胞S-100检查。结果 7例有内分泌活性颈动脉体瘤患者手术切除均成功,术后恢复满意。HE染色见肿瘤细胞,边缘可见支持细胞;免疫组化CgA(+)、S-100(+)证实均为颈动脉体瘤,来源于副神经节瘤,但病理活检无法证实内分泌活性。随访12～60月,未见复发。结论具有内分泌活性颈动脉体瘤以临床表现和实验室检查为主,病理无特异性。首选的治疗方式是外科切除,同时需要进行围手术期血钾、血压的严密监测。

Clinical and Pathological Characteristics and Surgical Treatment of Carotid Body Tumor with Endocrine Activity

Objective To investigate the clinical and pathological characteristics and surgical treatment of carotid body tumor with endocrine activity(CBT).Methods Records of seven CBT patients with endocrine activity(Jan,1991-Aug,2011) who underwent surgical excision of tumor were retrospectively reviewed.The operations were performed with the careful peroperative preparation on the control of blood pressure,serum potassium and catecholamine.All the tumors were studied with the methods of HE staining,immunohistochemistry of chromogranin A(CgA) and S-100.Results All the operations were successfully accomplished and the patients recovered quickly.It was confirmed with pathological examination that all the tumors were CBT,coming from paraganglioma.Tumor cells and sertoli cells were found in HE staining,and all were positive of CgA and S-100.All patients were followed up for 12-60 months and no recurrence was found during the follow up.Conclusion CBT with endocrine activity presents with identifiable clinical and pathological characteristics.The recommended treatment is surgical resection,careful perioperative preparation and care is important to avoid the severe complication due to the endocrine activity of tumor.