ShamblinⅢ型颈动脉体瘤手术治疗  

Treatment of Shamblin Ⅲ carotid body tumor

作　　者：陈晓红[1] 房居高[1] 张洋[1] 王琪[1] 梁熙宏[2] 郁正亚[3] 李勇[4] 于振坤[1] 黄志刚[1] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京100730 [2]首都医科大学附属北京同仁医院介入科,北京100730 [3]首都医科大学附属北京同仁医院血管外科,北京100730 [4]首都医科大学附属北京同仁医院神经外科,北京100730

出　　处：《中国耳鼻咽喉头颈外科》2012年第6期289-292,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的总结ShamblinⅢ型颈动脉体瘤的临床诊疗经验。方法回顾性分析2006～2011年ShamblinⅢ型颈动脉体瘤患者临床治疗经过及随访结果。7例患者中女性6例,男性1例;平均年龄30岁。术前暂时性球囊阻断试验测定球囊阻断耐受时间,同时检测颈内动脉返流压和Willis环前后交通支开放状况。DSA检测3例行术前颈内动脉和颈外动脉栓塞,2例行咽升动脉栓塞。手术入路包括:2例行颈侧联合枕下入路,3例下颌骨正中裂开,2例颈侧切口。2例术中行大隐静脉重建颈内动脉。结果随访6个月～6年,患者均健在,术后未出现颅内并发症。术中输血200～1500 ml,平均输血730 ml。2例颅内外沟通患者术后后组颅神经麻痹加重,加强锻炼1年后恢复正常工作,偶发进食呛咳;1例患者颈静脉孔颅内外沟通肿瘤3年后颈静脉孔处复发,伽马刀治疗后随访2年稳定。结论暂时性球囊阻断试验对ShamblinⅢ型颈动脉体瘤术前风险评估意义重大;颈动脉或瘤体责任血管的术前栓塞有利于减少术中出血;颅内外沟通的颈动脉体瘤需要多学科协作,术后要加强神经损伤后的功能锻炼。OBJECTIVE To discuss the clinical management of Shamblin Ⅲ carotid body tumors（CBTs）.METHODS The clinical treatment and follow-up data of 7 patients with CBTs from June,2006 to December,2011 were retrospectively analyzed.There were 6 female and one male.The mean age of the patients was 30 years.Temporary balloon occlusion（TBO）was used to test carotid reflux pressure and the open degree of the cranial anterior/posterior communicating artery.Three cases underwent internal carotid artery and the external carotid artery embolization,and two cases underwent ascending pharyngeal artery embolization.The tumors were removed via suboccipital approach in 2 cases,mandible split approach in 3 cases,transcervical approach in 2 cases.Internal carotid artery was reconstructed with great saphenous vein in 2 cases.RESULTS All patients were followed up from 6 months to 6 years without intracranial or extracranial complications.Average amount of blood transfusion during operation was 730ml（range 200 to 1500 ml）.Only one patient with extracranialintracranial communicating tumor recurred after 3 years and managed with Gamma Knife resection.This patient followed another 2 years without recurrence.Two cases with extracranial-intracranial communicating tumor had more severe symptoms of posterior-cranial nerve paralysis after surgery,whereas they can have liquid food after enhanced training.CONCLUSION Temporary balloon occlusion（TBO）test has vital significance on preoperative risk evaluation for Shamblin Ⅲ carotid body tumor.Selective vital artery embolism helps to decrease the bleeding during operation.The carotid body tumor,which had extracranial-intracranial communicating tumor,needs multi-disciplinary cooperation,and functional exercise is effective for patients with posterior-cranial nerve paralysis.

关 键 词：颈动脉体瘤 治疗 外科手术 

分 类 号：R739.91[医药卫生—肿瘤]