摘要
目的 :寻求一种对晚期头颈部恶性肿瘤累及颈动脉患者的外科治疗方法。方法 :对 4例头颈部恶性肿瘤 (舌癌、食道癌、喉癌、腮腺癌各 1例 )累及颈动脉患者 ,术前采用TCD、DSA、SPECT等检查脑血管耐受性 ,术中翻瓣解剖颈内动脉近颅端 ,用圆钻磨去 1cm岩骨段 (C5) ,使颈内动脉近颅端充分暴露。然后用Shunt管行颈总—颈内动脉分流 ,切除肿瘤及颈动脉 ,同时行颈动脉重建 (大隐静脉 1例 ,人造血管 3例 )胸大肌肌皮瓣修复创面 (3例 )。结果 :术后 2周～ 6月行B超、TCD等检查显示重建颈动脉通畅。 4例患者除 1例出现Honer′s综合征外均无脑神经症状和并发症。结论
Objective:The purpose of this study was to establish an ideal operation method to deal with head and neck carcinomas of late stage and involving the carotid.Methods: A total of four metastasized head neck carcinomas involving the carotid arteries were included in this clinical trail. The primary tumors of the four cases tumors were carcinomas of tongue, esophagus, laryngeal and parotid glands. All four cases were examined by means of TCD, DSA, SPECT to confirm good compatibility of brain blood circulation before operations. The bony petrous sections of carotid arteries were drawn off after the exposure of the bone tissue for exterior skull. A by_pass was set up by inserting a shunt tube between the common carotid and the infernal carotid artery. The extended tumor resection was carried out involving the resection of the carotid artery. The artery was reconstructed with saphena magna vein transplantation in one case, and replaced by artificial vessels in two cases. Tissue defects were repaired by pedicle PMMF.Results: The B_typed ultrasound and TCD examination two weeks to six months post_operatively showed the four cases revealed good condition of transplanted carotid arteries, except one case occurred Honer's syndrome, but there was no central nerve's symptom or complication in the other three cases.Conclusion:This operation method could provide a good chance of survival by curettage of later staged head neck tumors. The authors recommend reconstruction of carotid artery in the operation treatment of malignant head neck carcinomas during late stages.
出处
《华西口腔医学杂志》
CAS
CSCD
北大核心
2002年第1期24-26,共3页
West China Journal of Stomatology
