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研究颈动脉体瘤切除术后神经症状短期恢复的影响因素。

Study on the Influencing Factors of Short-Term Recovery of Neurological Symptoms after Carotid Body Tumor Resection.

机构信息

Department of Neurosurgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.

Department of Radiology, Peking University Third Hospital, Beijing, China.

出版信息

World J Surg. 2023 Oct;47(10):2542-2553. doi: 10.1007/s00268-023-07068-4. Epub 2023 Jun 6.

Abstract

OBJECTIVE

To compare the differences in the short-term recovery from neurological symptoms (SRN) (≤ 6 months) and clinical characteristics of patients with different Shamblin classifications carotid body tumor (CBT) resection and to analyze the risk factors affecting SRN after surgery.

METHODS

Patients who underwent CBT resection between June 2018 and September 2022 were recruited. Perioperative factors and indicators of the nature of the tumor were recorded. The risk factors affecting SRN after CBT resection were analyzed using logistic regression analysis.

RESULTS

Eighty-five patients (43.86 ± 12.7 years, 46 females) were included, 40 (47.06%) of whom exhibited SRN. Univariate logistic regression showed that preoperative symptoms, surgical side, bilateral posterior communicating artery (PcoA) opening, some indicators of tumor size, operative/anesthesia time, and Shamblin III classification were correlated with postoperative neurological prognosis (all p < 0.05). After adjusting for confounders, preoperative symptoms (OR, 5.072; 95% CI 1.027-25.052; p = 0.046), surgical side (OR, 0.025; 95% CI 0.003-0234; p = 0.001), bilateral PcoA opening (OR, 22.671; 95% CI 2.549-201.666; p = 0.005), distance from the tip of the C2 dens to the superior aspect (dens-CBT) (OR, 0.918; 95% CI 0.858-0.982; p = 0.013) and Shamblin III classification (OR, 28.488; 95% CI 1.986-408.580; p = 0.014) were correlated with postoperative neurological symptom recovery.

CONCLUSION

Preoperative symptoms, surgical side (right), bilateral PcoA opening, a short dens-CBT and Shamblin III classification are risk factors affecting SRN after CBT resection. Early resection is recommended for small-volume CBTs without neurovascular compression or invasion to obtain SRN.

摘要

目的

比较不同 Shamblin 分类颈动脉体瘤(CBT)切除术患者短期神经症状恢复(SRN)(≤6 个月)的差异和临床特征,并分析影响术后 SRN 的危险因素。

方法

招募 2018 年 6 月至 2022 年 9 月期间行 CBT 切除术的患者。记录围手术期因素和肿瘤性质指标。采用 logistic 回归分析 CBT 切除术后影响 SRN 的危险因素。

结果

共纳入 85 例患者(43.86±12.7 岁,46 例女性),其中 40 例(47.06%)出现 SRN。单因素 logistic 回归显示,术前症状、手术侧、双侧后交通动脉(PcoA)开放、部分肿瘤大小指标、手术/麻醉时间和 Shamblin Ⅲ分类与术后神经预后相关(均 p<0.05)。调整混杂因素后,术前症状(OR,5.072;95%CI,1.027-25.052;p=0.046)、手术侧(OR,0.025;95%CI,0.003-0234;p=0.001)、双侧 PcoA 开放(OR,22.671;95%CI,2.549-201.666;p=0.005)、C2 椎体尖至 CBT 顶端的距离(dens-CBT)(OR,0.918;95%CI,0.858-0.982;p=0.013)和 Shamblin Ⅲ分类(OR,28.488;95%CI,1.986-408.580;p=0.014)与术后神经症状恢复相关。

结论

术前症状、手术侧(右侧)、双侧 PcoA 开放、短 dens-CBT 和 Shamblin Ⅲ分类是影响 CBT 切除术后 SRN 的危险因素。对于无神经血管压迫或侵犯的小体积 CBT,建议早期切除以获得 SRN。

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