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。

Diagnosis and treatment of 21 patients with carotid body tumor

Objective：To summarize the experience in diagnosis and treatment of carotid body tumors（CBT） and explore the preoperative preparation,operation methods and prevention of the complications. Methods： Twenty-one patients with CBT were performed ultrasonography examination before surgical operation;8 cases received digital subtraction radiography and 13 multi-slice spiral CT angiography or magnetic resonance angiography. All the 21 cases underwent Matas test before operation;10 patients received resection of the tumor only,7 cases resection of the tumor along with the external carotid artery,4 cases vascular reconstruction of the carotid artery after resection of the tumor body,carotid artery,external carotid artery and the common carotid artery. Results：Complete resection of the CBT was achieved in all the 21 cases. No death,paralysis or blindness occurred after surgery. Distortion of commissure was observed in 1 case,Horner＇s syndrome in 1 case,hoarseness in 1 case,crooked tongue in 1 case and bucking while drinking in 1cases. Twenty patients were followed up for a period of 4 months to 15 years,with no tumor recurrence or metastases. Conclusions：Preoperative color Dopple,selective angiography and multi-slice spiral CT angiography or magnetic resonance angiograph may help to confirm the diagnosis;surgical resection is the choice of treatment for carotid body tumor. Diminishing the cerebral ischemia time and protecting the cerebral nerve are essential for the prevention of serious postoperative complications.