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[介绍一种保留颈内动脉切除颈动脉体瘤的新方法——显微凝固法]

[To introduce a new method of resection of carotid body tumor with preservation of the internal carotid artery ----microscopic coagulation method].

作者信息

Zhang Qing, Hua Qingquan, Hua Rongkai, Jiang Yang, Ren Jie

机构信息

Department of Otolaryngology Head and Neck Surgery,People's Hospital of Wuhan University,Wuhan,430060,China.

出版信息

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024 Sep;38(9):812-817. doi: 10.13201/j.issn.2096-7993.2024.09.007.

Abstract

To introduce the surgical experience of carotid body tumor(CBT) resection with preservation of internal carotid artery. The clinical data of 109 patients with CBT were retrospectively analyzed. The key points of surgical techniques were summarized, the imaging and pathological results were comprehensively analyzed, and the postoperative complications were observed. Of the 109 patients, 28 were Shamblin Ⅰ, 46 were Shamblin Ⅱ, and 35 were Shamblin Ⅲ. Synaptophysin(SYN) and soluble protein-100(S-100) were positive in all cases. There was a positive correlation between the average expression area percentage of S-100 and SYN in pathological tissue of 17 patients(=0.48), and the difference was statistically significant(<0.05). The average operation time was(148.4±46.2) minutes, the average intraoperative blood loss was(64.7±22.8) mL, and the average hospital stay was(15.2±2.6) days. Three patients underwent tumor resection combined with external carotid artery ligation, 1 patient underwent tumor resection combined with internal carotid artery ligation, and the remaining patients underwent tumor resection alone. The overall rate of intraoperative vascular ligation was 3.7% and the rate of nerve injury was 6.4%. According to preoperative CTA, intraoperative situation and postoperative pathological results, a new classification of CBT was proposed, which could intuitively reflect the gap between the tumor and the carotid artery and the nature of the tumor. Surgical resection of CBT is recommended after diagnosis. The potential gap between the tumor and the blood vessels was found under the microscope. Low energy bipolar electrocoagulation was used to coagulate and cut off the fibrous connective tissue between the tumor and gradually separated along the adventitia of the artery. The carotid artery could be preserved in most cases while the tumor was completely removed, and the amount of intraoperative bleeding and the incidence of complications were reduced. It is particularly important to identify the difficult cases before operation.

摘要

介绍保留颈内动脉的颈动脉体瘤(CBT)切除术的手术经验。回顾性分析109例CBT患者的临床资料。总结手术技巧要点,综合分析影像学及病理结果,并观察术后并发症。109例患者中,ShamblinⅠ型28例,ShamblinⅡ型46例,ShamblinⅢ型35例。所有病例突触素(SYN)和可溶性蛋白100(S-100)均为阳性。17例患者病理组织中S-100与SYN平均表达面积百分比呈正相关(r=0.48),差异有统计学意义(P<0.05)。平均手术时间为(148.4±46.2)分钟,平均术中出血量为(64.7±22.8)毫升,平均住院时间为(15.2±2.6)天。3例患者行肿瘤切除联合颈外动脉结扎术,1例患者行肿瘤切除联合颈内动脉结扎术,其余患者单纯行肿瘤切除术。术中血管结扎总发生率为3.7%,神经损伤发生率为6.4%。根据术前CTA、术中情况及术后病理结果,提出了一种新的CBT分类方法,该方法能直观反映肿瘤与颈动脉的间隙及肿瘤性质。建议确诊后行CBT手术切除。在显微镜下发现肿瘤与血管之间的潜在间隙。采用低能量双极电凝凝固并切断肿瘤与血管之间的纤维结缔组织,沿动脉外膜逐渐分离。多数情况下可在完整切除肿瘤的同时保留颈动脉,减少术中出血量及并发症发生率。术前识别困难病例尤为重要。

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本文引用的文献

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[A case of cervical lymph node metastasis after carotid body tumor surgery].[1例颈动脉体瘤手术后出现颈部淋巴结转移的病例]
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Jun;36(6):475-476. doi: 10.13201/j.issn.2096-7993.2022.06.014.
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[The surgical treatment of carotid body tumor and prevention and treatment of complications].
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2018 May;32(9):713-716. doi: 10.13201/j.issn.1001-1781.2018.09.018.
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A pediatric carotid body tumor.小儿颈动脉体瘤。
J Pediatr Surg. 2018 Jul;53(7):1432-1436. doi: 10.1016/j.jpedsurg.2018.04.004. Epub 2018 Apr 7.

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