鼻内镜颅底手术中颈内动脉损伤五例成功救治体会  

Experience of successful rescue from 5 cases of internal carotid artery injury during transnasal endoscopic skull base surgery

作　　者：尹飞 孙敬武 汪银凤 郭涛[1] 赵婉 Yin Fei, Sun Jingwu, Wang Yinfeng, Guo Tao, Zhao Wan(Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of University of Science of Technology of China ,Anhui Provincial Hospital, Hefei 230001, China)

机构地区：[1]中国科学技术大学附属第一医院安徽省立医院耳鼻咽喉头颈外科,合肥230001

出　　处：《中华耳鼻咽喉头颈外科杂志》2018年第4期251-256,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金青年项目（81600793）;安徽省自然科学基金青年项目（1608085QH224）

摘　　要：目的探讨鼻内镜颅底手术中，颈内动脉损伤破裂出血的原因及紧急处理方法，总结临床经验与教训。方法回顾性分析2010年11月至2017年7月，于中国科学技术大学附属第一医院安徽省立医院耳鼻咽喉头颈外科行内镜鼻颅底手术并发颈内动脉损伤破裂出血的5例患者的临床资料，包括腺样囊性癌2例、涎腺型腺癌1例、岩尖部胆固醇肉芽肿1例、鳞状细胞癌1例，分析手术过程中颈内动脉损伤的原因及后续救治经过，总结经验与教训。结果5例患者中2例行颈内动脉覆膜支架植入，1例患者行颈内动脉瘘口局部颞肌填塞，1例行鼻咽部、后鼻孔填塞止血，1例填塞止血失败后行颈总动脉结扎术。5例患者经积极治疗后均止血成功，无死亡病例，除颈总动脉结扎患者遗留有肢体活动障碍，其他患者均无严重颅内外并发症发生。随访6～84个月，5例患者均存活。结论内镜颅底手术中，颈内动脉损伤多与操作不当及解剖定位不准有关，一旦发生即要果断采取有效止血措施，并寻求多学科合作以修复颈内动脉损伤。Objective To investigate the cause and urgent management of internal carotid artery injury during transnasal endoscopic skull base surgery. Methods Five cases of internal carotid artery injury encountered during transnasal endoscopic skull base surgery in Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of University of Science of Technology of China, Anhui Provincial Hospital from December 2010 to July 2017 were analysed retrospectively. There were 2 cases of adenoid cystic carcinoma, 1 case of salivary gland-type adenocarcinoma, 1 case of petrous apex cholesterol granulomas and 1 case of squamous carcinoma. The cause of internal carotid artery injury and subsequent treatment were analysed, in order to prevent internal carotid artery injury during transnasal endoscopic surgery. Results Intraoperatively, all these 5 cases were packed with vaseline strip successfully. Two cases underwent subsequent intravascular covered stent graft implantation ; 1 case underwent replacement of packing with muscle fascia graft; 1 case was packed with vaseline strip in nasal and nasopharyngeal cavity; 1 case accepted ligation of common carotid artery after failure of nasal packing. Four cases were successfully treated without craniocerebral or ocular complications. Otherwise, 1 case demonstrated with extremity paralysis after ligation. Follow up ranged from 6 to 84 months, no patient died. Conclusion The injury of internal carotid artery is related with improper operative procedures and anatomic localization, which should be treated properly with emergent hemostasis, and an experienced muhidisciplinary team to repair vascular damage is very important.

关 键 词：内窥镜 颅底 颈内动脉破裂 手术中并发症 

分 类 号：R762[医药卫生—耳鼻咽喉科]