目的 探討介入聯(lián)合頸內(nèi)動(dòng)脈轉(zhuǎn)流在Ⅲ型頸動(dòng)脈體瘤切除術(shù)中的應(yīng)用及效果。
方法 回顧性分析筆者所在醫(yī)院自2002年1月至2012年7月期間收治的21例(22側(cè))Ⅲ型頸動(dòng)脈體瘤患者的臨床資料。21例患者術(shù)前經(jīng)充分評(píng)估后,于術(shù)前2~3d均用微導(dǎo)管對(duì)供瘤血管行超選擇栓塞治療,然后在頸內(nèi)動(dòng)脈轉(zhuǎn)流下行頸動(dòng)脈體瘤切除術(shù)。
結(jié)果 21例(22側(cè))手術(shù)均順利完成,術(shù)后經(jīng)病理學(xué)檢查證實(shí)均為頸動(dòng)脈體瘤。其中行頸動(dòng)脈瘤切除術(shù)16例(17側(cè)),瘤體切除+頸內(nèi)動(dòng)脈重建5例(其中自體大隱靜脈3例,人工血管2例)。術(shù)后當(dāng)天則出現(xiàn)神經(jīng)并發(fā)癥5例(舌歪3例,面部麻木2例),術(shù)后3個(gè)月內(nèi)均恢復(fù)正常; 無(wú)腦梗塞、偏癱和死亡病例。21例均獲隨訪(fǎng),隨訪(fǎng)時(shí)間2個(gè)月~9年,平均57個(gè)月,無(wú)復(fù)發(fā)病例。
結(jié)論 頸動(dòng)脈體瘤首選的治療方式是外科切除,介入聯(lián)合頸內(nèi)動(dòng)脈轉(zhuǎn)流下切除Ⅲ型頸動(dòng)脈體瘤瘤體是安全有效的。
引用本文: 施森,楊輝,周翔宇,宋麗,何延政. 介入聯(lián)合頸內(nèi)動(dòng)脈轉(zhuǎn)流在Ⅲ型頸動(dòng)脈體瘤切除術(shù)中的應(yīng)用. 中國(guó)普外基礎(chǔ)與臨床雜志, 2013, 20(10): 1088-1091. doi: 復(fù)制
1. | Georgiadis GS, Lazarides MK, Tsalkidis A, et al. Carotid body tumor in a 13-year-old child:Case report and review of the literature[J]. J Vasc Surg, 2008, 47(4):874-880. |
2. | Shamblin WR, ReMine WH, Sheps SG, et al. Carotid body tumor(chemodectoma). Clinocopathological analysis of ninety cases[J].Am J Surg, 1971, 122(6):732-739. |
3. | 金畢, 賴(lài)傳善, 樂(lè)格芬, 等. 頸動(dòng)脈體瘤的診斷和治療(附26例報(bào)告)[J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 1999, 6(1):36-37. |
4. | Sajid MS, Hamilton G, Baker DM, et al. A multicenter review of carotid body tumor management[J]. Eur J Vasc Endovasc Surg, 2007, 34(2): 127-130. |
5. | Luna-Ortiz K, Rageon-Ortiz M, Villavicencio-Valencia V, et al. Carotid body tumor: review of a 20-year experience[J]. Oral Oncol, 2005, 41(1): 56-61. |
6. | 胡紹童, 皮厚山, 華道亮, 等. 頸動(dòng)脈體瘤CT和DSA的影像學(xué)表現(xiàn)對(duì)比研究[J]. 中國(guó)臨床醫(yī)學(xué)影像雜志, 2010, 21(4):271-273. |
7. | Kuwada C, Mannion K, Aulino JM, et al. Imaging of the carotidspace[J]. Otolaryngol Clin North Am, 2012, 45(6) : 1273-1292. |
8. | 張德智, 馬天璇, 李丹, 等. 頸動(dòng)脈體瘤的CT、MRI診斷[J]. 臨床放射學(xué)雜志, 2008, 27(4):452-454. |
9. | Li J, Wang S, Zee C, et al. Preoperative angiography and transa-rterial embolization in the management of carotid body tumor:a single-center, 10-year experience[J]. Neurosurgery, 2010, 67 (4):941-948. |
10. | Zeitler DM, Glick J, Har-El G. Preoperative efflbolization in carotid body tumor sugery:is it required?[J]. Ann Otol Bhinol Laryngol, 2010, 119(5):279-283. |
11. | Lim JY, Kim J, Kim SH, et al. Surgical treatment of carotid body paragangliomas:outcomes and complications according to the shambling classification[J]. Clin Exp Otorhinolaryngol, 2010, 3(2): 9l-95. |
12. | 胡敏, 張立海, 楊舸, 等. 選擇性血管栓塞術(shù)輔助頸動(dòng)脈體瘤切除術(shù)[J]. 華西口腔醫(yī)學(xué)雜志, 2010, 28(4): 387-390. |
13. | Sahin MA, Jahollari A, Guler A, et al. Results of combined preo-perative direct percutaneous embolization and surgical excision in treatment of carotid body tumors[J]. Vasa, 2011, 40(6):461-466. |
14. | Power AH, Bower TC, Kasperbauer J et al. Impact of preopera-tive embolization on outcomes of carotid body tumor resections[J]. J Vasc Surg, 2012, 56(4):979-989. |
15. | 趙紀(jì)春, 馬玉奎, 黃斌, 等. 術(shù)中頸內(nèi)動(dòng)脈轉(zhuǎn)流在頸動(dòng)脈體瘤切除中的作用[J]. 中華普通外科雜志, 2010, 25(7):533-535. |
16. | 楊斌, 張承磊. 頸動(dòng)脈體瘤外科治療安全性探討(附39例病例分析)[J]. 昆明醫(yī)學(xué)院學(xué)報(bào), 2010, 31(3):54-58. |
17. | 章希煒, 楊宏宇, 孫蓬, 等. 頸動(dòng)脈內(nèi)膜剝脫術(shù)治療動(dòng)脈粥樣硬化性頸內(nèi)動(dòng)脈閉塞癥[J]. 中華普通外科雜志, 2006, 21(10): 727-728. |
18. | Sunar H, Keles C, Besirli K. Elective shunt use for easy resectionof a carotid body tumor[J]. Vascular, 2008, 16(1): 41-43. |
19. | 李然, 盧向陽(yáng), 楊震, 等. 包裹型頸動(dòng)脈體瘤手術(shù)嚴(yán)重并發(fā)癥救治[J]. 口腔醫(yī)學(xué), 2013, 33(2):119-121. |
20. | Vogel TR, Mousa AY, Dombrovskiy VY, et al. Carotid bodytumor surgery:management and outcomes in the nation[J]. VascEndovasc Surg, 2009, 43(5):457-461. |
21. | 陳建華, 徐健, 馬文鋒, 等. 頸動(dòng)脈體瘤的診斷與手術(shù)治療[J].中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(4):385-386. |
22. | Knight TT Jr, Ganzalez JA, Rary JM, et a1. Current concepts for the surgical management of carotid body tumor[J]. Am J Surg, 2006, 191(1): 104-110. |
23. | Hendrikse J, Hartkamp MJ, Hillen B, et al. Collateral ability of the circle of Willis in patients with unilateral internal carotid artery occlusion:border zone infarcts and clinical symptoms[J]. Stroke, 2001, 32(12):2768-2773. |
24. | 王玉琦, 陳斌, 符偉國(guó), 等. 頸動(dòng)脈體瘤的手術(shù)并發(fā)癥[J]. 中華普通外科雜志, 2005, 20(9): 549-551. |
25. | 周翔宇, 楊輝, 鐘武, 等. 頸動(dòng)脈體瘤15例的外科診治體會(huì)[J]. 臨床外科雜志, 2011, 19(3): 176-178. |
- 1. Georgiadis GS, Lazarides MK, Tsalkidis A, et al. Carotid body tumor in a 13-year-old child:Case report and review of the literature[J]. J Vasc Surg, 2008, 47(4):874-880.
- 2. Shamblin WR, ReMine WH, Sheps SG, et al. Carotid body tumor(chemodectoma). Clinocopathological analysis of ninety cases[J].Am J Surg, 1971, 122(6):732-739.
- 3. 金畢, 賴(lài)傳善, 樂(lè)格芬, 等. 頸動(dòng)脈體瘤的診斷和治療(附26例報(bào)告)[J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 1999, 6(1):36-37.
- 4. Sajid MS, Hamilton G, Baker DM, et al. A multicenter review of carotid body tumor management[J]. Eur J Vasc Endovasc Surg, 2007, 34(2): 127-130.
- 5. Luna-Ortiz K, Rageon-Ortiz M, Villavicencio-Valencia V, et al. Carotid body tumor: review of a 20-year experience[J]. Oral Oncol, 2005, 41(1): 56-61.
- 6. 胡紹童, 皮厚山, 華道亮, 等. 頸動(dòng)脈體瘤CT和DSA的影像學(xué)表現(xiàn)對(duì)比研究[J]. 中國(guó)臨床醫(yī)學(xué)影像雜志, 2010, 21(4):271-273.
- 7. Kuwada C, Mannion K, Aulino JM, et al. Imaging of the carotidspace[J]. Otolaryngol Clin North Am, 2012, 45(6) : 1273-1292.
- 8. 張德智, 馬天璇, 李丹, 等. 頸動(dòng)脈體瘤的CT、MRI診斷[J]. 臨床放射學(xué)雜志, 2008, 27(4):452-454.
- 9. Li J, Wang S, Zee C, et al. Preoperative angiography and transa-rterial embolization in the management of carotid body tumor:a single-center, 10-year experience[J]. Neurosurgery, 2010, 67 (4):941-948.
- 10. Zeitler DM, Glick J, Har-El G. Preoperative efflbolization in carotid body tumor sugery:is it required?[J]. Ann Otol Bhinol Laryngol, 2010, 119(5):279-283.
- 11. Lim JY, Kim J, Kim SH, et al. Surgical treatment of carotid body paragangliomas:outcomes and complications according to the shambling classification[J]. Clin Exp Otorhinolaryngol, 2010, 3(2): 9l-95.
- 12. 胡敏, 張立海, 楊舸, 等. 選擇性血管栓塞術(shù)輔助頸動(dòng)脈體瘤切除術(shù)[J]. 華西口腔醫(yī)學(xué)雜志, 2010, 28(4): 387-390.
- 13. Sahin MA, Jahollari A, Guler A, et al. Results of combined preo-perative direct percutaneous embolization and surgical excision in treatment of carotid body tumors[J]. Vasa, 2011, 40(6):461-466.
- 14. Power AH, Bower TC, Kasperbauer J et al. Impact of preopera-tive embolization on outcomes of carotid body tumor resections[J]. J Vasc Surg, 2012, 56(4):979-989.
- 15. 趙紀(jì)春, 馬玉奎, 黃斌, 等. 術(shù)中頸內(nèi)動(dòng)脈轉(zhuǎn)流在頸動(dòng)脈體瘤切除中的作用[J]. 中華普通外科雜志, 2010, 25(7):533-535.
- 16. 楊斌, 張承磊. 頸動(dòng)脈體瘤外科治療安全性探討(附39例病例分析)[J]. 昆明醫(yī)學(xué)院學(xué)報(bào), 2010, 31(3):54-58.
- 17. 章希煒, 楊宏宇, 孫蓬, 等. 頸動(dòng)脈內(nèi)膜剝脫術(shù)治療動(dòng)脈粥樣硬化性頸內(nèi)動(dòng)脈閉塞癥[J]. 中華普通外科雜志, 2006, 21(10): 727-728.
- 18. Sunar H, Keles C, Besirli K. Elective shunt use for easy resectionof a carotid body tumor[J]. Vascular, 2008, 16(1): 41-43.
- 19. 李然, 盧向陽(yáng), 楊震, 等. 包裹型頸動(dòng)脈體瘤手術(shù)嚴(yán)重并發(fā)癥救治[J]. 口腔醫(yī)學(xué), 2013, 33(2):119-121.
- 20. Vogel TR, Mousa AY, Dombrovskiy VY, et al. Carotid bodytumor surgery:management and outcomes in the nation[J]. VascEndovasc Surg, 2009, 43(5):457-461.
- 21. 陳建華, 徐健, 馬文鋒, 等. 頸動(dòng)脈體瘤的診斷與手術(shù)治療[J].中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(4):385-386.
- 22. Knight TT Jr, Ganzalez JA, Rary JM, et a1. Current concepts for the surgical management of carotid body tumor[J]. Am J Surg, 2006, 191(1): 104-110.
- 23. Hendrikse J, Hartkamp MJ, Hillen B, et al. Collateral ability of the circle of Willis in patients with unilateral internal carotid artery occlusion:border zone infarcts and clinical symptoms[J]. Stroke, 2001, 32(12):2768-2773.
- 24. 王玉琦, 陳斌, 符偉國(guó), 等. 頸動(dòng)脈體瘤的手術(shù)并發(fā)癥[J]. 中華普通外科雜志, 2005, 20(9): 549-551.
- 25. 周翔宇, 楊輝, 鐘武, 等. 頸動(dòng)脈體瘤15例的外科診治體會(huì)[J]. 臨床外科雜志, 2011, 19(3): 176-178.