Verhaeghe Jean-Luc, Montagne Serge, Belotzerkovski Igor, Bracard Serge, Henneton Catherine, Lapeyre Michel, Meistelman Claude, Dolivet Gilles
Département de chirurgie, Centre de lutte contre le cancer Alexis-Vautrin, avenue de Bourgogne, 54511 Vandoeuvre-lès-Nancy, France.
Bull Cancer. 2003 Jul;90(7):607-13.
Head and neck squamous cell carcinomas may involve the carotid artery. Surgical treatment of these tumors is a difficult challenge, because of related morbidity and mortality. The aim of this study of international literature was to define the best preoperative and intraoperative strategy which permits carotid resection with acceptable neurologic risk. Pre-operative evaluation of cerebral tolerance to carotid occlusion is performed. If the patient has successfully completed the 30-minute temporary occlusion of the internal carotid artery, a permanent balloon occlusion is performed. Surgical treatment includes carotid resection with or without revascularization using an autogenous graft. Elective carotid resection without reconstruction results in cerebral complications in 0 to 25% of patients, and death in 0 to 30% of patients. If a reconstruction using a graft is performed, cerebral complications occur in 0 to 22% of patients, and death in 0 to 33% of patients. Anastomotic rupture occurs in 0 to 33% of patients. However, many authors reported no neurologic complications and no deaths after performing successful preoperative permanent balloon occlusion of the internal carotid associated with carotid resection. Carotid resection can be performed with an acceptable cerebral risk in selected patients. Preoperative carotid occlusion seems to result in decreased postoperative mortality and morbidity rates. Prospective studies should be done to clarify the benefit of this procedure.
头颈部鳞状细胞癌可能累及颈动脉。由于相关的发病率和死亡率，对这些肿瘤进行手术治疗是一项艰巨的挑战。本国际文献研究的目的是确定最佳的术前和术中策略，以便在可接受的神经风险下进行颈动脉切除术。需对大脑对颈动脉闭塞的耐受性进行术前评估。如果患者成功完成了30分钟的颈内动脉临时闭塞，则进行永久性球囊闭塞。手术治疗包括使用自体移植物进行有或无血管重建的颈动脉切除术。选择性颈动脉切除而不进行重建，0%至25%的患者会出现脑部并发症，0%至30%的患者会死亡。如果进行移植物重建，0%至22%的患者会出现脑部并发症，0%至33%的患者会死亡。0%至33%的患者会发生吻合口破裂。然而，许多作者报告称，在成功进行术前永久性球囊闭塞颈内动脉并联合颈动脉切除术后，没有神经并发症和死亡病例。在选定的患者中，可以在可接受的脑部风险下进行颈动脉切除术。术前颈动脉闭塞似乎可降低术后死亡率和发病率。应开展前瞻性研究以阐明该手术的益处。
