Zhang Zhi-yuan, Zhu Han-guang, Sun Jian, Zhang Chen-ping, Zheng Jia-wei, Fan Xin-dong
Department of Oral and Maxillofacial Surgery, School of Stomatology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China.
Zhonghua Kou Qiang Yi Xue Za Zhi. 2006 Jan;41(1):25-8.
To retrospectively analyze a single institution's experience with surgery of the carotid artery performed as part of an oncological procedure and emergency hemostasis, with the aim to determine the preoperative methods for evaluation of cerebral circulation, selection of surgical procedures and perioperative complications.
From January 1999 to December 2004, a total of 35 patients underwent carotid artery surgery including repair of carotid artery in 7 cases, ligation or resection of carotid artery in 17 cases, and reconstruction of carotid artery in 11 cases. All the patients were evaluated for blood flow in the circle of Willis with DSA, DSA plus TBO plus SPECT, and TCD and followed up from 4 months to 4 years. The perioperative complications and surgical outcomes were recorded and analyzed.
There were 16 carotid body tumors, 1 malignant carotid body tumor, 17 malignant tumors involving the carotid artery and 1 traumatic arterio-venous fistula. Twenty-seven patients underwent carotid occlusion test, 10 were positive and 17 were negative (tolerable). Of 7 cases with repair of the carotid artery, 1 patient died of uncontrolled bleeding due to rupture of the anastomosis, and the remaining was uneventful. Of 17 cases with ligation or resection of the carotid artery, 4 developed neurologic deficit 2 weeks postoperatively. Three patients with malignant tumors died 1 month, 4 months, and 4 months postoperatively, respectively. One patient with carotid artery body tumor complained of inarticulate speech 4 months after operation; another patient complained of incapability and limited movement of the ipsilateral upper limbs; 5 patients complained of dizziness 4, 6, 12, 24 and 48 months postoperatively. Of 11 patients who underwent carotid reconstruction, no major cerebral complications were noted after operation. One patient died of recurrence, 1 patient with carotid body tumor complained inarticulate speech and incapability of the contralateral limbs, the remaining was uneventful. Color Doppler showed patent vascular graft 1 year postoperatively.
TBO plus SPECT is a reliable method for evaluation of the circle of Willis currently. The short term and long term complications of ligation of carotid artery are high, therefore, resection and revascularization of the carotid artery is advocated for carotid artery tumors when possible.
回顾性分析单一机构在作为肿瘤手术和紧急止血一部分进行的颈动脉手术方面的经验，旨在确定脑循环评估的术前方法、手术方式的选择及围手术期并发症。
1999年1月至2004年12月，共有35例患者接受了颈动脉手术，其中7例为颈动脉修复术，17例为颈动脉结扎或切除术，11例为颈动脉重建术。所有患者均通过数字减影血管造影（DSA）、DSA联合氙-133吸入试验（TBO）及单光子发射计算机断层扫描（SPECT）以及经颅多普勒超声（TCD）对Willis环血流进行评估，并随访4个月至4年。记录并分析围手术期并发症及手术结果。
有16例颈动脉体瘤，1例恶性颈动脉体瘤，17例累及颈动脉的恶性肿瘤及1例创伤性动静脉瘘。27例患者进行了颈动脉闭塞试验，10例阳性，17例阴性（可耐受）。7例颈动脉修复术中，1例患者因吻合口破裂出血无法控制死亡，其余情况良好。17例颈动脉结扎或切除术中，4例术后2周出现神经功能缺损。3例恶性肿瘤患者分别于术后1个月、4个月和4个月死亡。1例颈动脉体瘤患者术后4个月出现言语不清；另1例患者主诉同侧上肢无力及活动受限；5例患者术后4、6、12、24和48个月出现头晕。11例接受颈动脉重建术的患者术后未出现重大脑部并发症。1例患者死于复发，1例颈动脉体瘤患者主诉对侧肢体言语不清及无力，其余情况良好。术后1年彩色多普勒显示血管移植物通畅。
目前，TBO联合SPECT是评估Willis环的可靠方法。颈动脉结扎的短期和长期并发症发生率较高，因此，对于颈动脉肿瘤，尽可能提倡行颈动脉切除及血管重建术。
