鼻内镜手术颈内动脉损伤3例  

Internal carotid artery injury during endoscopic endonasal surgery:3 cases report

作　　者：张竹萍[1] 杨景朴[1] 赵胤[1] 程金章[1] 陈康兵[1] 李松[1] 王宗贵[1] 

机构地区：[1]吉林大学第二医院耳鼻咽喉科,长春130041

出　　处：《临床耳鼻咽喉头颈外科杂志》2017年第11期885-887,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：1 病例报告 例1 女，49岁。因“鼻腔平滑肌肉瘤术后13年，鼻出血1周”入院。鼻内镜检查见右侧鼻腔后部肿物，根部位于右侧鼻腔外侧壁，表面灰红色，触之质脆，易出血。鼻窦CT及MRI提示鼻腔及蝶窦内不规则软组织密度影，与颅内尚有界限。入院经活检病理诊断为（鼻腔）平滑肌肉瘤。于2007年7月5日全身麻醉下行鼻侧切开联合鼻内镜下肿瘤切除术，术中见肿瘤来源于右鼻腔外侧壁及蝶窦，大小约为5.0 cm×4.0 cm×4.0 cm，蝶窦前壁被破坏，外侧壁及后壁变软。辅助鼻内镜下切除后部残留肿瘤，见肿瘤与蝶窦外侧壁粘连，在用剥离子分离肿瘤至蝶窦外下壁时，突然出血，出血迅猛。立即使用纱条填塞蝶窦止血，并行右侧颈外动脉结扎。结扎完毕撤出纱条时仍旧出血，遂行右侧颈内动脉及颈总动脉结扎，再次撤出纱条，无活动性出血。考虑肿瘤已侵及颈内动脉，剥离残余肿瘤，术毕。术中输红细胞悬液1 000 ml，血浆350 ml。术后患者出现左侧偏瘫，伴有神志不清。急行头部CT示右侧颈内动脉闭塞，颞叶、额叶、枕叶大片状低密度影，中线移位。转入神经外科，后家属放弃治疗，3 d后死亡。Three cases of internal carotid artery（ICA） injury during endoscopic endonasal surgery were ana- lyzed, including 1 case of recurrent malignancy of sphenoid sinus, 1 case of intraorbital meningioma and 1 case of optic neuropathy. Salvage sphenoid sinus packing with gauze strip was managed in all the three cases. One patient operated a permanent closure of the carotid system intraoperatively and died after surgery. Among 2 survival ca- ses, one patient accepted the endovascular embolization subsequently; the other patient was cured by intravaseular stent graft implantation without craniocerebral or ocular complicatitms.

关 键 词：内镜检查 外科手术 颈内动脉 并发症 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]