颈动脉体瘤外科治疗的单中心经验  

A single-center experience of surgical treatment of carotid body tumor

作　　者：秦原森 王劲松 姚陈[1] 胡作军[1] 王冕[1] 李梓伦[1] 武日东[1] 王斯文[1] 王深明[1] 常光其[1] Qin Yuansen;Wang Jinsong;Yao Chen;Hu Zuojun;Wang Mian;Li Zilun;Wu Ridong;Wang Siwen;Wang Shenming;Chang Guangqi(Department of Vascular Surgery,First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China;Department of Vascular and Plastic Surgery,Guangdong Provincial People's Hospital,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院血管外科,广州510080 [2]广东省人民医院血管与整形外科,广州510080

出　　处：《中华血管外科杂志》2022年第4期269-274,共6页Chinese Journal of Vascular Surgery

基　　金：广州市科技计划基础与应用基础项目(202201011820)。

摘　　要：目的总结单中心颈动脉体瘤(CBT)的手术治疗经验,探讨CBT手术效果相关影响因素。方法回顾性分析中山大学附属第一医院1981年7月至2020年12月收治的193例(210例次)CBT患者的临床资料,其中17例接受了双侧手术治疗,176例接受单侧手术治疗。210例次患者中,ShamblinⅠ型31例次(14.8%),Ⅱ型85例次(40.5%),Ⅲ型94例次(44.8%);高位瘤体56例次(26.7%)。瘤体最大直径中位数4.7(3.5,5.5)cm。收集患者出血量、手术时间、动脉干预、影像学情况及并发症情况等。比较分析不同Shamblin分型、瘤体位置的患者CBT手术出血量和手术时间。采用多因素Logistic回归分析CBT手术动脉干预和颅神经损伤的影响因素。结果210例次CBT手术中有156例次(74.3%)行术前栓塞。术中需动脉干预54例次(25.7%)。中位出血量为100(50,300)ml,中位手术时间为180.0(130.0,241.3)min。多因素Logistic回归分析显示Shamblin分型是动脉干预的独立影响因素(OR=5.966,95%CI:2.639~13.487,P<0.001)。围术期脑梗死9例次,围术期内颅神经损伤(至少1种颅神经损伤)61例次,包括发生率较高的有迷走神经41例次,舌下神经30例次,喉上神经16例次。多因素Logistic回归分析显示高位瘤体为颅神经损伤的独立危险因素(OR=3.165,95%CI:1.511~6.630,P=0.002)。187例患者获得随访,随访中位时间为51.5(35.3,100.8)个月。颈内动脉闭塞10例次,其中人工血管闭塞6例次,术后直接缝合2例次,大隐静脉重建闭塞1例次,其他静脉置换1例次。结论Shamblin分型和CBT的垂直位置有助于评估手术难度和预测术后并发症风险。Shamblin分型是动脉干预的独立影响因素。颅神经损伤是最常见的术后并发症,高位瘤体为颅神经损伤的独立危险因素。Objective To summarize a single-center experience of surgical treatment of carotid body tumor(CBT)and explore the factors influencing the surgical outcome of CBT.Methods A retrospective analysis was performed for the clinical data of 193 patients(210 cases)with CBT admitted to the First Affiliated Hospital of Sun Yat-sen University from July 1981 to December 2020.Among the patients,17 patients underwent bilateral surgery and 176 unilateral surgery.Among 210 cases,31(14.8%)were Shamblin typeⅠ,85(40.5%)were typeⅡ,and 94(44.8%)were typeⅢ.There were 56 cases(26.7%)of upper tumors.The median maximum diameter of the tumor was 4.7(3.5,5.5)cm.The information on blood loss,operative time,arterial intervention,imaging,and complications was collected.The blood loss and operative time of different Shamblin classifications and the location of tumors of the CBT patients were compared.Multivariate logistic regression was performed to analyze the factors of arterial intervention and cranial nerve injury affecting the CBT surgery.Results Among 210 cases,156 cases(74.3%)underwent preoperative embolization.There were 54 cases(25.7%)requiring arterial intervention during surgery.The median blood loss was 100(50,300)ml and the median operative time was 180.0(130.0,241.3)min.Multivariate logistic regression analysis showed that Shamblin classification was an independent influencing factor for arterial intervention(OR=5.966,95%CI:2.639-13.487,P<0.001).There were 9 cases of cerebral infarction and 61 cases of cranial nerve injury(at least one type of cranial nerve injury)during the perioperative time,including 41 cases of vagus nerve injury,30 cases of hypoglossal nerve injury,and 16 cases of superior laryngeal nerve injury.Multivariate logistic regression analysis showed that upper tumors were the independent influencing factors for cranial nerve injury(OR=3.165,95%CI:1.511-6.630,P=0.002).187 cases were followed up for 51.5(35.3,100.8)months.There were 10 cases of internal carotid artery occlusion,including 6 cases of artificial

关 键 词：颈动脉体瘤 术前栓塞 动脉干预 颅神经损伤 手术治疗 

分 类 号：R739.4[医药卫生—肿瘤]