颈动脉体瘤无血手术切除技术探讨(附12例报告)  

Exploration of the technique of bloodless surgical resection of carotid body tumor:A report of 12 cases

作　　者：黄亚波[1] 周鹏[1] 韩庆东[1] 陆晓诚 惠品晶[1] 颜艳红 张世明[1] 王中[1] 刘济生[1] Huang Yabo;Zhou Peng;Han Qingdong;Lu Xiaocheng;Hui Pinjing;Yan Yanhong;Zhang Shiming;Wang Zhong;Liu Jisheng(Department of Neurosurgery,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院神经外科,江苏215006

出　　处：《中华神经外科杂志》2020年第8期823-828,共6页Chinese Journal of Neurosurgery

基　　金：苏州市姑苏卫生人才计划第五批科研项目(GSWS2019002)。

摘　　要：目的探讨应用显微神经外科技术实现无血手术切除颈动脉体瘤的手术经验。方法回顾性分析2016年1月至2019年8月苏州大学附属第一医院神经外科收治的12例颈动脉体瘤患者的临床资料。12例患者均为单侧病变(左侧7例,右侧5例)。肿瘤体积最小为4.2 cm×3.0 cm×3.0 cm,最大为8.0 cm×6.5 cm×4.0 cm。12例患者中,肿瘤血供来源于颈外动脉及其分支9例,来源于颈动脉和颈内动脉2例,来源于椎动脉1例。其中,影像学Shamblin分级为Ⅱ级者7例,Ⅲ级5例。1例患者术前行选择性肿瘤供血动脉(椎动脉的肌椎动脉)栓塞术。12例患者均于显微镜下行颈动脉体瘤切除术,术后复查头颅CT、MRI观察有无脑出血、脑梗死等并发症,行颈动脉超声检查评估血管有无闭塞、狭窄。出院后门诊随访行颈动脉超声和CT血管成像(CTA)检查,评估有无肿瘤复发、血管狭窄及卒中事件发生等。结果12例患者均成功切除颈动脉体瘤,手术时间为(95±25)min(60~180 min)。1例ShamblinⅢ级患者术中出现两处颈动脉破裂,采用缝合止血,出血量为150 ml;其余11例术中出血量为(30±12)ml(20~50 ml)。术中均无输血。12例患者的病理学结果均为副神经节瘤。围手术期无死亡病例,12例患者中,出现暂时性舌下神经损伤1例,1例复查CTA可见颈动脉缝合处管腔轻度狭窄,无脑梗死等并发症。所有患者均完成随访,随访时间为(18±8)个月(6~36个月)。至末次随访,12例患者均未见肿瘤复发、脑梗死等,未出现死亡病例。1例暂时性舌下神经损伤患者术后6个月时伸舌偏斜、吞咽困难症状缓解。结论应用显微神经外科技术,在阻断颈动脉体瘤主要血供后,沿动脉外膜-瘤体包膜界面锐性分离,在干净无血的术野内操作,保护好周围脑神经,最大程度地切除肿瘤,可以实现安全、无血地切除颈动脉体瘤。Objective To explore the experience of microneurosurgical technique to achieve bloodless excision of carotid body tumors(CBT).Methods The clinical data of 12 patients of CBT at Department of Neurosurgery,the First Affiliated Hospital of Soochow University from January 2016 to August 2019 were retrospectively analyzed in this study.Of the patients,4 cases were males and 8 were females.All cases had unilateral(the left in 7 cases and the right in 5)lesion.The tumors were at least 4.2 cm×3.0 cm×3.0 cm,and at most 8.0 cm×6.5 cm×4.0 cm.Among the 12 patients,tumor blood supply was from external carotid artery and its branches in 9 cases,from carotid artery and internal carotid artery in 2 cases,and from vertebral artery in 1 case.According to the imaging Shamblin classification:7 were classified as Shamblin typeⅡand 5 were typeⅢ.One patient underwent selective tumor supplying artery(musculovertebral artery)embolization before surgery.All 12 patients underwent carotid body tumor resection under the microscope.Postoperative cranial CT and MRI were performed to observe whether there were hemorrhage,infarction and other complications,and carotid ultrasound was performed to check whether the vessels had occlusion or stenosis.Carotid ultrasound and CTA were followed up at outpatient clinic after discharge to evaluate whether there were tumor recurrence,vascular stenosis and stroke events.Results Surgical excision was successfully performed in 12 cases.The operation duration was 95±25 min(60-180 min).One of the ShamblinⅢpatients had the rupture of carotid artery in two sites,suture hemostasis was employed,and the blood loss was 150 ml.The remaining 11 cases had intraoperative blood loss of 30±12 ml(20-50 ml).No intraoperative blood transfusion was applied.The pathological diagnosis of all 12 cases was paraganglioma.There were no perioperative deaths.Temporary hypoglossal nerve palsy occurred in 1 case.There was 1 case of slight stenosis at the suturing site of carotid artery indicated by CT reexamination.No compli

关 键 词：颈动脉体瘤 显微外科手术 手术后并发症 无血手术 

分 类 号：R739.91[医药卫生—肿瘤]