颈内动脉搭桥术在头颈部副神经节瘤切除手术中的应用  

Reconstruction of internal carotid artery in the resection of paraganglioma of head and neck

作　　者：田旭[1] 孙慧颖 冯国栋 郑月宏 陈钰 赵杨[1] 张立芹 薛松波 高志强[1] TIAN Xu;SUN Huiying;FENG Guodong;ZHENG Yuehong;CHEN Yu;ZHAO Yang;ZHANG Liqin;XUE Songbo;GAO Zhiqiang(Department of Otorhinolaryngology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100730,China;Department of Vascular Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College;Department of Radiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College)

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喉科,北京100730 [2]中国医学科学院、北京协和医学院、北京协和医院血管外科 [3]中国医学科学院、北京协和医学院、北京协和医院放射科

出　　处：《临床耳鼻咽喉头颈外科杂志》2024年第9期802-807,811,共7页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：中央高水平医院临床科研专项(No:2022-PUMCH-B-095)。

摘　　要：目的探讨在副神经节瘤手术中应用颈内动脉搭桥技术的必要性、手术方法及效果。方法回顾性研究2015年5月至2023年8月就诊于北京协和医院行头颈部副神经节瘤切除术并行颈内动脉重建术的患者资料,包括人口学特征、术前检查、诊断、术中对颈内动脉的处理技术及术后随访情况。结果共纳入6例患者,包括女4例,男2例;平均年龄(39.8±13.0)岁;以颈部包块伴或不伴疼痛为主要症状,影像学检查均提示肿瘤完全包绕颈内动脉。4例患者行Fisch颞下窝入路Type A+B、1例Type A、1例经颈侧入路手术。5例以大隐静脉、1例以人工血管重建颈内动脉。平均随访时间为(43.8±31.6)个月。1例患者肿瘤于3年后复发并再次行手术切除,其余5例未见肿瘤复发。1例患者发生急性桥接血管栓塞,另1例桥接血管在随访时发现闭塞。结论在累及颈内动脉的头颈部副神经节瘤切除手术中行颈动脉搭桥术是彻底切除肿瘤、治愈疾病,同时保证颅内血供、降低脑血管并发症的重要技术。“预重建技术”较常规颈动脉搭桥手术缩短了单次阻断脑血流的时间,一定程度上降低了发生脑血管事件的风险。颈动脉搭桥术后应密切观察患者的临床症状并定期复查影像学检查以评估移植血管的通畅程度及肿瘤残留或复发的情况。Objective This study aims to discuss the necessity,surgical method and effect of reconstruction of internal carotid artery(ICA)in the resection of paraganglioma of head and neck.Methods We retrospectively analyzed the data of the patients who underwent head and neck paraganglioma resection and ICA reconstruction in Peking Union Medical College Hospital from May 2015 to August 2023.The demographic characteristics,preoperative examinations,diagnoses,surgical techniques,and follow-up information were collected.Results Six patients were enrolled,including four females and two males,with an average age of(39.8±13.0)years.All the patients presented mainly complaining local masses with or without pain.Four cases underwent surgery through Fisch infratemporal fossa approach type A+B,and one through approach type A and one through transcervical approach.Five patients had vascular reconstruction using the great saphenous vein while one patient used an artificial vessel.The average follow-up period was(43.8±31.6)months.One patient had tumor recurrence after 3 years and underwent second surgery to remove the residual tumor,and the other 5 patients had no tumor recurrence.One patient had acute bridging vessel embolism,and the other was found to have occlusion of the bridging vessel at follow-up.Conclusion Carotid revascularization during resection of paraganglioma of head and neck is an important technique to completely remove the tumor,cure the disease,ensure intracranial blood supply,and reduce cerebrovascular complications.The"pre-reconstruction technique"is an effective method to minimize the duration of brain blood flow interruption,compared to traditional carotid revascularization.Close observation is necessary,along with regular radiological examinations to assess the patency of transplanted vessels,and the residual or recurrent tumors.

关 键 词：头颈部副神经节瘤 颞下窝入路 颈内动脉重建 预重建技术 

分 类 号：R739.4[医药卫生—肿瘤]