侧颅底肿瘤手术中对颈内动脉的处理:41例病例回顾  

Management of the internal carotid artery during lateral skull base surgery:a series of 41 cases

作　　者：孙慧颖 高志强[1] 田旭[1] 赵杨[1] 张立芹 杨睿哲 冯国栋 Sun Huiying;Gao Zhiqiang;Tian Xu;Zhao Yang;Zhang Liqin;Yang Ruizhe;Feng Guodong(Department of Otorhinolaryngology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院耳鼻咽喉科,北京100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2022年第7期804-809,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：北京市科技计划项目(Z191100007619040)。

摘　　要：目的总结侧颅底肿瘤切除术中对颈内动脉的处理方法和结局,探讨术前根据影像学检查明确肿瘤与颈内动脉之间的关系对合理制定手术方案的参考价值。方法收集2015年5月至2021年5月在北京协和医院接受侧颅底肿瘤切除术(累及颈内动脉)患者的临床资料,包括性别、年龄、术前检查、诊断、手术经过及随访情况等。共41例患者纳入研究,其中女性24例(58.5%),男性17例(41.5%),平均年龄47.9岁。根据术前影像学资料将肿瘤与颈内动脉的关系分为毗邻、压迫、侵袭和源发于颈内动脉的动脉瘤,分别观察术中肿瘤与颈内颈动脉的关系及对颈内动脉的处理方法和结局。结果32例(78.0%,32/41)颈内动脉得到保留,9例(22.0%,9/41)颈内动脉进行了重建。27例(65.9%,27/41)在影像学上与颈内动脉呈毗邻关系的肿瘤均成功自血管表面分离;11例(26.8%,11/41)压迫颈内动脉的肿瘤中,5例成功自血管表面分离,另外6例无法自血管表面分离而行血管重建;1例(2.4%,1/41)侵袭颈内动脉的肿瘤及2例(4.9%,2/41)颈内动脉瘤进行了血管重建。术后平均随访时间为(26.1±2.9)月,除1例腺样囊性癌患者术后1年发生脑转移,其余病例均无复发。结论术前影像学提示与颈内动脉呈毗邻关系的侧颅底肿瘤,通常可与颈内动脉分离;压迫颈内动脉的肿瘤术前应做好血管重建的准备,术中首先尝试分离,分离失败则进行血管重建;侵袭颈内动脉管壁的肿瘤及源发于颈内动脉的动脉瘤,在术中可直接将肿瘤与受累段颈内动脉一同切除并进行血管重建。术前根据影像学结果明确肿瘤与颈内动脉之间关系对合理制定手术方案具有较好的参考价值。Objective To introduce our experience on dealing with the internal carotid artery(ICA)during the resection of lateral skull base tumors,and to explore the reference values for using radiological findings to make a rational surgical plan.Methods A retrospective study of patients who underwent resection of lateral skull base tumors involving ICA at Peking Union Medical College Hospital from May 2015 to May 2021 was conducted.The demographic information,preoperative examinations,diagnosis,surgical details and follow-ups were collected.A total of 41 patients were enrolled[24(58.5%]females,17(41.5%)males],with an average age of 47.9 years.According to the preoperative imaging findings,the relationships between the tumors and ICA were divided into four types:adjacency,compression,invasion and ICA aneurysm.Results The ICA was preserved in 32(78.0%,32/41)cases and was reconstructed in nine(22.0%,9/41)cases.All the 27(65.9%,27/41)tumors adjacent to ICA were successfully separated from the artery.Among the 11 tumors compressing the ICA,six were resected with the involved ICA segment and vascular reconstruction was conducted.One(2.4%,1/41)tumor invading ICA and two(4.9%,2/41)ICA aneurysms required revascularization.The mean follow-up time was(26.1±2.9)months.There was no recurrence,except one case of adenoid cystic carcinoma which had brain metastases one year after surgery.Conclusions According to the preoperative imaging,lateral skull base tumors adjacent to ICA can be detached from the vascular surface.Separation should be attempted first for tumors compressing ICA,and revascularization should be followed if separation failed.Vascular reconstruction is usually needed in the removal of tumors invading ICA and ICA aneurysms.Preoperative radiology can provide good references for planning a surgery for lateral skull base tumors.

关 键 词：侧颅底 肿瘤 颈内动脉 影像学 耳外科手术 

分 类 号：R739.41[医药卫生—肿瘤]