Wu Zhongkai, Liu Yehai, Zhang Liang, Wu Kaile, Wu Jing, Zhao Yi, Yao Changyu, Wang Yang
Department of Otorhinolaryngology Head and Neck Surgery，First Affiliated Hospital of Anhui Medical University，Hefei，230022，China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Jan 5;35(1):24-28. doi: 10.13201/j.issn.2096-7993.2021.01.006.
To explore the significance of preoperative cervical thoracic enhancement CT and CTA in the selection of different tumor surgical methods at the base of the neck to minimize complications. Analysing the clinical data of 51 patients who had cervical root tumor surgery, including 24 benign lesions and 27 malignant tumors. Enhanced CT and/or CTA examinations were used before surgery to understand the relationship between tumors and/ or recurrent or metastatic lesions and the unnamed arteriovenous, internal jugular arteriovenous, clavicular arteriovenous, thyroid neck, and cone arteries of the cervical root. According to the preoperative enhanced CT and/or CTA, the tumor was removed by a simple neck incision approach or an endoscopic assisted neck incision approach or a combined neck and chest approach. The patients were followed up for 6 months to 10 years. All 24 benign lesions were completely removed. Twenty-seven cases of malignant tumors were completely resected, 2 cases were palliative and cytoreductive, and no death occurred during the operation; There were 2 cases of hoarseness in 27 cases of malignant tumors in this group; 1 case of permanent hypoparathyroidism, died of complications 1 year after surgery; 1 case of subclavian artery injury and 1 case of subclavian vein rupture, repaired during operation; 2 cases of chylous leakage were cured after timely negative pressure suction and compression; 1 case of pleural trauma was repaired during the operation; 1 case of brachial plexus nerve and sacral nerve injury. One case had mediastinal infection after median dehiscence of the sternum was cured after 3 months of treatment. For different nature and different types of tumors at the neck-thoracic junction, appropriate surgical approaches should be selected according to preoperative enhanced CT and CTA to fully expose the tumors. While effectively protecting important neurovasculature, timely and effective treatment of intraoperative complications, so that it is feasible to safely remove part of the cervical root tumor.
探讨术前颈胸增强CT及CTA在颈部根部不同肿瘤手术方式选择中的意义，以减少并发症。分析51例行颈根部肿瘤手术患者的临床资料，其中良性病变24例，恶性肿瘤27例。术前采用增强CT和/或CTA检查，了解肿瘤与/或复发或转移灶以及无名动静脉、颈内动静脉、锁骨动静脉、甲状腺颈血管、颈根部锥动脉的关系。根据术前增强CT和/或CTA，采用单纯颈部切口入路、内镜辅助颈部切口入路或颈胸联合入路切除肿瘤。对患者进行6个月至10年的随访。24例良性病变均完整切除。27例恶性肿瘤中，27例完整切除，2例为姑息性减瘤手术，术中无死亡病例；该组27例恶性肿瘤中有2例出现声音嘶哑；1例永久性甲状旁腺功能减退，术后1年死于并发症；1例锁骨下动脉损伤，1例锁骨下静脉破裂，术中修复；2例乳糜漏经及时负压吸引和压迫治愈；1例胸膜损伤术中修复；1例臂丛神经及骶神经损伤。1例胸骨正中裂开后纵隔感染，经3个月治疗治愈。对于颈胸交界区不同性质和不同类型的肿瘤，应根据术前增强CT和CTA选择合适的手术入路，充分暴露肿瘤。在有效保护重要神经血管的同时，及时有效处理术中并发症，使安全切除部分颈根部肿瘤成为可能。
