球囊暂时阻断技术辅助外科治疗颈动脉相关肿瘤  

Temporary Balloon Occlusion Technology as Auxiliary Surgical Treatment for Carotid Arteries Near Tumors

作　　者：张强[1] 张仑[1] 张文超[1] 王旭东[1] 郭志[2] 邢文阁[2] 

机构地区：[1]天津市肿瘤防治重点实验室,天津医科大学附属肿瘤医院头颈一科,天津市300060 [2]天津市肿瘤防治重点实验室,天津医科大学附属肿瘤医院介入科,天津市300060

出　　处：《中国肿瘤临床》2010年第24期1467-1470,共4页Chinese Journal of Clinical Oncology

摘　　要：目的:术前利用球囊暂时性阻断技术(temporary balloon occlusion,TBO)评价患者对颈内动脉切除后的耐受程度,以选择适当的手术方式,提高颈动脉外科治疗的安全性。方法:术前对15例患者行球囊暂时性阻断技术,阻断颈动脉30min,观察并记录球囊阻断前后的神经系统的变化。术中根据TBO评价及残端动脉压测定辅助选择手术方式。尽量实施保留或重建颈动脉术式,慎用颈动脉直接结扎术式。结果:行颈动脉阻断评价的15例中,12例阴性,3例阳性。阳性病例表现为大脑Willis环代偿不全和(或)神经功能障碍。该组1例阳性病例为高龄的晚期肿瘤患者未行手术治疗,2例行肿瘤及颈动脉切除的同时行人造血管重建颈动脉。TBO评价阴性者4例结扎颈总动脉均未出现神经功能障碍,余8例阴性者均保留了颈动脉,无神经功能障碍。在本组病例中,行手术切除颈动脉的无神经功能障碍症状组的患者残端动脉平均压>73mmHg。结论:利用球囊暂时性阻断辅助外科技术,对可能在术中切除颈内动脉的患者进行术前耐受性评价,有利于制定科学的手术方式,提高颈动脉切除的安全性。Objective： To assess patients＇ tolerance for resection of the carotid artery before surgery by using the temporary balloon occlusion （TBO） technology, and to select the appropriate surgical method to improve the safety of surgery for the carotid artery. Methods： Before surgery 15 patients underwent the blocking technology, using a balloon to temporarily block the carotid artery for 30 min to observe and record the reaction of the nervous system. Intraoperative surgical methods were selected according to TBO elevation and artery nub pressure. Carotid reservation or rebuilding was performed as far as possible. Permanent carotid ligation should be avoided if possible. Results： Fifteen patients underwent TBO assess- ment, including 12 negative cases and 3 positive cases. Positive signs included the presence of neurologic symptoms during the temporary occlusion and an angiographically incomplete Willis＇ Circle. Among the 3 positive patients, 1 elderly patient did not complete surgical treatment because of advanced cancer. Two cases underwent tumor and carotid artery resection, and at the same time the carotid artery was reconstructed by artificial blood vessels. Permanent carotid occlusion was performed in 4 negative patients. Eight negative patients retained the carotid artery. Postoperatively, no negative patients developed neurologic symptoms. In patients with surgical resection of the carotid artery without neurological dysfunction, artery hub pressure was more than 73 mmHg. Conclusion： Temporary balloon occlusion is useful in evaluating whether a patient can tolerate carotid resection without developing neurologic deficits, and can assist in planning the best surgical treatment strategy by which a safe resection of the carotid artery is completed successfully.

关 键 词：颈动脉切除术 外科治疗 球囊暂时性阻断试验 

分 类 号：R739.9[医药卫生—肿瘤]