Katsuno S
Department of Otolaryngology, Shinshu University School of Medicine, Matsumoto.
Nihon Jibiinkoka Gakkai Kaiho. 1995 Sep;98(9):1407-15. doi: 10.3950/jibiinkoka.98.1407.
Since 1990, in treating 10 cases with head and neck tumors which had invaded the carotid artery, the authors have performed vascular reconstruction of the carotid artery. The standard surgical procedure is en bloc resection of the tumor and carotid artery and one stage ipsilateral vascular reconstruction of the carotid artery at cervical operation using a temporary shunt tube. When the tumor is located in a distal or proximal cervical portion, craniotomy or thoracotomy is needed in addition to the usual surgical procedure. The author classifies one stage ipsilateral reconstruction of the carotid artery into four types, depending on the anastomotic site, and describes distal or proximal limits of this procedure at cervical operation. Type A: Cervical operation after partial resection of the carotid wall; Patch angioplasty or simple arteriorrhaphy. Type B: Cervical operation after round resection of the carotid wall; Common carotid-internal carotid artery graft interposition, etc. Type C: Using craniotomy in addition to the cervical operation; Common carotid-middle cerebral artery bypass, etc. Type D: Using thoracotomy in addition to the cervical operation; Transthoracic subclavian-internal carotid artery bypass, etc. The design of the operative technique and adjunct enable distal or proximal limits of this procedure to be expanded. It is necessary to discuss the limits of this procedure in each case. Selecting an adequate surgical procedure based on intraoperative findings requires close teamwork with neurosurgeons and thoracic surgeons.
自1990年以来，作者在治疗10例侵犯颈动脉的头颈部肿瘤时，对颈动脉进行了血管重建。标准手术方法是在颈部手术中整块切除肿瘤和颈动脉，并使用临时分流管一期进行同侧颈动脉血管重建。当肿瘤位于颈部远端或近端时，除常规手术外还需要开颅手术或开胸手术。作者根据吻合部位将同侧颈动脉一期重建分为四种类型，并描述了该手术在颈部手术中的远端或近端界限。A型：颈动脉壁部分切除后行颈部手术；补片血管成形术或单纯动脉缝合术。B型：颈动脉壁环形切除后行颈部手术；颈总动脉-颈内动脉移植术等。C型：除颈部手术外还采用开颅手术；颈总动脉-大脑中动脉搭桥术等。D型：除颈部手术外还采用开胸手术；经胸锁骨下动脉-颈内动脉搭桥术等。手术技术和辅助手段的设计使该手术的远端或近端界限得以扩大。有必要针对每种情况讨论该手术的界限。根据术中发现选择合适的手术方法需要与神经外科医生和胸外科医生密切协作。
