永久性球囊阻断术在头颈肿瘤累及颈动脉近颅段切除中的价值

目的：探讨在头颈肿瘤累及颈动脉近颅段的外科根治中术前应用永久性球囊阻断技术的价值。方法：2002年3月-2005年12月,对10例术前成功耐受暂时性球囊阻断（TBO）试验的头颈部肿瘤侵犯高位颈动脉患者,行颈内动脉永久球囊阻断（PBO）,并于PBO术后2～14d内行颅颌联合根治术（3例）、颅外扩大根治术（7例）;术后缺损区行远位或邻近组织瓣修复,其中游离背阔肌皮瓣4例、带蒂胸大肌皮瓣3例、颞肌筋膜组织瓣1例、邻近组织瓣2例。结果：10例患者术前均成功耐受TBO,其残端动脉压（SP）≥50mmHg,均值为61.4mmHg。10例患者行颈内动脉PBO术后,1例于阻断后24h内出现脑梗死症状,经对症治疗后症状明显改善;2例患者于阻断后24～48h内出现短暂脑缺血症状;其余7例患者阻断后均无脑供血不足表现。10例肿瘤均完整切除,所有移植组织瓣移植均存活,伤口一期愈合。10例患者手术后非阻断侧上、下肢体肌力评价9例均为5级;另1例上肢为4级,下肢为5级。10例患者随访6～24个月,未见肿瘤复发,无颅神经症状。结论：对于头颈肿瘤累及高位颈动脉的患者,采用颈内动脉颅内段永久性球囊阻断技术,不仅能有效控制出血,而且能简化手术,降低风险,并安全地实施肿瘤根治性切除。

The role of permanent balloon occlusion in resection of head and neck tumor involving cranial segment of internal carotid artery

PURPOSE：To evaluate the role of preoperative permanent balloon occlusion（PBO） in resection of head and neck tumor involving near cranial segment of internal carotid artery.METHODS：From March 2002 to December 2005,PBO was performed in internal carotid artery in 10 patients with head and neck tumor involving near cranial segment of internal carotid artery,who tolerated temporary balloon occlusion（TBO）.Two to fourteen days after PBO,3 patients underwent craniolfacial resection,while 7 patients underwent extra-cranial resection.Latissimus dorsi myocutaneous flap（n=4）,pectoralis major myocutaneous flap（n=3）,temporal musculofacial flap（n=1）,and adjacent flaps（n=2） were used to repair the defect after resection.RESULTS：TBO was successfully performed in 10 patients.Carotid stump pressures were greater than 50mmHg and the average carotid stump pressure was 61.4mmHg.After PBO in internal carotid artery,1 patient suffered from cerebral infarction within 24 hours and the symptom was improved dramatically after treatment,2 patients suffered from transient cerebral ischemia,other 7 patients did not develop neurologic signs and symptoms.En bloc resection was performed in 10 patients and all flaps survived with primary wound healing.Postoperative muscle forces of contralateral limbers were 5 degrees in all patients except that of contralateral upper limber was 4 degrees in 1 patient.During the period of 6 to 24 months follow-up,no patient was found recurrence and neurologic symptom.CONCLUSION：For patients with head and neck tumor involving near cranial segment of internal carotid artery,PBO in internal carotid artery could be used to not only control bleeding but also simplify operation and reduce risk with radical resection.