颈内动脉支架在颈静脉球副神经节瘤手术中的应用  

Application of internal carotid artery stent in glomus jugular paraganglioma surgery

作　　者：王涛[1,2] 吴雅琴 王菁菁 于栋祯[1,2] 时海波 陈正侬[1,2] 王鹏军 殷善开[1,2] WANG Tao;WU Yaqin;WANG Jingjing;YU Dongzhen;SHI Haibo;CHEN Zhengnong;WANG Pengjun;YIN Shankai(Department of Skull Base Surgery Center,Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai,200233,China;Department of Otolaryngology Head and Neck Surgery,Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine)

机构地区：[1]上海交通大学医学院附属第六人民医院颅底外科中心,上海200233 [2]上海交通大学医学院附属第六人民医院耳鼻咽喉头颈外科

出　　处：《临床耳鼻咽喉头颈外科杂志》2024年第9期797-801,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：国家自然科学基金资助项目(No:82171140);上海交通大学医工交叉基金项目(No:YG2021QN106)。

摘　　要：目的本文旨在总结颈内动脉支架在颈静脉球副神经节瘤手术中的应用,为降低颈内动脉损伤风险提供了有效的策略。方法本文回顾了2018年6月至2022年12月采用颈内动脉支架的手术案例,并探讨了支架置入方法、治疗方案及围手术期的管理策略。结果本研究共5例患者,术前根据MRI、颈动脉CT血管造影(CTA)及数字减影血管造影(DSA)等影像学技术,对颈内动脉受侵犯程度进行全面评估,显示所有患者颈内动脉均受到不同程度的累及。术前对所有患者行颈内动脉支架置入术,置入过程顺利,未发生颈内动脉损伤。支架置入后3个月行肿瘤全切或次全切除手术,术中避免了颈内动脉损伤,手术过程顺利完成。术后随访4个月~2年,支架置入后颈内动脉通畅,内皮化进程良好,未出现支架相关并发症。结论对于颈静脉球副神经节瘤患者,若术前影像学显示颈内动脉受累,术前支架置入是一种安全有效的治疗策略,可加固动脉壁结构,保护并维持动脉完整性,降低手术过程中血管损伤的风险。本文总结了颈内动脉支架在颈静脉球副神经节瘤手术中的应用经验,为临床实践提供了重要参考。Objective To summarize the application of internal carotid artery stent in glomus jugular paraganglioma surgery,and to provide an effective strategy for reducing the risk of internal carotid artery injury.Methods This article reviewed the surgical cases of internal carotid artery stent implanting from 2018.06 to 2022.12,and discussed the stent placement method,treatment protocols,and perioperative management strategies.Results A total of 5 patients underwent a comprehensive evaluation of the degree of internal carotid artery invasion using imaging techniques such as MRI,carotid CT angiography(CTA),and digital silhouette angiography(DSA).All patients were found to have varying degrees of internal carotid artery involvement.Stenting of the internal carotid artery was performed in all patients before surgery,and the stenting process went smoothly without any internal carotid artery injury.Three months after stenting,tumor resection or subtotal resection surgery was performed to avoid internal carotid artery injury during the surgery,and the surgical process was successfully completed.Postoperative follow-up from 4 months to 2 years showed that the internal carotid artery was patent after stent placement,with great endothelialization process and no stent-related complications.Conclusion In patients with glomus jugular paraganglioma,when preoperative imaging shows internal carotid artery involvement,preoperative stenting is a safe and effective therapeutic strategy to reinforce the arterial wall structure,protect and maintain the integrity of the artery,and reduce the risk of vascular injury during the surgery.This article summarizes the experience of internal carotid artery stent in glomus jugular paraganglioma surgery,which provides an important reference for clinical practice.

关 键 词：颈内动脉支架 颈静脉球副神经节瘤 手术 抗凝治疗 

分 类 号：R739.4[医药卫生—肿瘤]