23例侧颅底手术中颈内动脉的处理  

Management of internal carotid artery in 23 cases of lateral skull base surgery

作　　者：汪照炎[1] 吴皓[1] 黄琦[1] 李幼瑾[1] 吴医婕[1] 张治华[1] 贾欢[1] 

机构地区：[1]上海交通大学医学院新华医院耳鼻咽喉-头颈外科,上海200092

出　　处：《上海交通大学学报（医学版）》2007年第1期50-53,共4页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的探讨侧颅底手术中颈内动脉的处理方法及效果。方法回顾性分析23例侧颅底手术中颈内动脉的处理,处理方法包括供血血管栓塞以及球囊压迫、轮廓化、分离、推移和切除。结果10例接受血管造影检查,其中7例行血管栓塞;10例中8例行球囊压迫试验,7例耐受,1例不耐受;7例耐受者中6例在术中行颈内动脉切除,1例出现神经血管并发症。所有肿瘤均经手术全切除。术中轮廓化颈内动脉3例,与肿瘤分离5例,推移7例,切除颈内动脉7例;另有1例术前颈内动脉已闭锁。除1例外所有病例术后均未发生神经血管并发症。2例鼻咽癌术后复发,1例复发鼻咽癌术后因心肺并发症死亡,1例胆脂瘤术后复发,其余19例随访至今无复发。结论术前颈内动脉功能评估,术中仔细操作和术后护理是颈内动脉处理效果良好的关键。Objective To explore the ways and outcomes of managing internal carotid artery （ICA） in lateral skull base surgery. Methods The management of ICA in 23 cases of lateral skull base surgery was retrospectively studied. The ways of management included embolization of donor vessels and balloon occlusion, skeletonization, dissection, mobilization and resection. Results Ten cases underwent angiography preoperatively in which embolization was succeeded in 7. Balloon occlusion was performed in 8 cases in which one was intolerable and the other 7 successful. Six of the seven patients who tolerated balloon occlusion received ICA resection, while postoperative neurovascular complication was occurred in one. Total tumor removal was achieved in all the 23 cases. Skeletonization of ICA was attempted in 3 cases, and dissection, mobilization and resection were applied in 5, 7 and 7 cases, respectively. And another one received ICA occlusion before surgery. No neurovascular complications were occurred except one case. One patient died of cardiopulmonary complication, and recurrence was found in 2 with nasopharyngeal carcinoma and 1 with cholesteatoma during the follow-up. No recurrence was found in the other 19 cases. Conclusion Detailed preoperative evaluation, proficient surgical procedure and cautious postoperative care are the keys to better prognosis of ICA.

关 键 词：颈内动脉 侧颅底 血管造影 手术 

分 类 号：R651.11[医药卫生—外科学]