摘要
目的:探讨在复杂颈动脉体瘤(CBT)手术过程中应用转流管的安全性及时机选择。方法:回顾性对比分析北京大学人民医院血管外科2002年1月—2018年3月收治的Shamblin Ⅱ、Ⅲ型CBT共85例手术患者的临床资料,其中33例应用转流管(转流管组),另52例未应用转流管(非转流管组),分析、比较两组患者的相关临床资料。结果:转流管组中Shamblin Ⅲ型患者比例明显多于非转流管组(P<0.05),其他术前一般资料两组间无统计学差异(均P>0.05)。转流管组33例均行颈内动脉重建,大隐静脉补片修补9例,因破裂严重行端端吻合重建共24例;非转流管组52例患者中,2例行颈内动脉重建同时颈外动脉结扎, 14例行单纯颈外动脉结扎,6例行颈外动脉重建。转流管组的手术时间、术中出血、短期神经并发症发生率较非转流管组明显增加(均P<0.05),但两组在术后动脉狭窄发生率、长期神经损伤发生率无统计学差异(均P>0.05)。结论:复杂Shamblin Ⅱ、Ⅲ型CBT术中采用颈动脉转流是一种安全的治疗手段,不会增加术中心血管系统并发症的风险,同时对长期神经损伤无明显影响。如出现颈动脉破裂可以尽快应用转流管维持颅内血流,可能有助于减少相对的出血及手术时间,同时减少神经不可逆损伤的发生。
Objective: To investigate the safety and timing selection of using shunt tube during surgery for complicated carotid body tumor(CBT).Methods: The clinical data of 85 patients with Shamblin Ⅱ or Ⅲ CBT undergoing surgical resection in the Department of Vascular Surgery, Peking University People’s Hospital between January 2002 and March 2018 were retrospectively analyzed. Of the patients, the carotid shunt tube was used in 33 cases(shunt tube group), and was not used in the other 52 cases(non-shunt tube group). The main clinical variables of the two groups of patients were analyzed and compared. Results: The proportion of cases with ShamblinⅢ tumor was significantly higher in shunt tube group than that in non-shunt tube group(P<0.05), but no significant differences were noted in other preoperative data between the two groups(P>0.05). In shunt tube group, all the 33 cases underwent internal carotid artery reconstruction, 9 cases had repair with a great saphenous vein patch, and 24 cases underwent reconstruction by end-to-end anastomosis due to severe rupture. Of the 52 patients in non-shunt tube group, 2 cases underwent internal carotid artery reconstruction and simultaneous external carotid artery ligation, 14 cases underwent simple external carotid artery ligation, and 6 cases underwent external carotid artery reconstruction. The operative time, intraoperative blood loss and incidence of short-term neurological complications were significantly increased in shunt tube group compared with non-shunt tube group(all P<0.05), while no statistical differences were found in incidence of postoperative arterial stenosis and long-term neurological injury between the two groups(both P>0.05). Conclusion: Using a carotid shunt tube in surgery for complex Shamblin Ⅱ orⅢ CBT is a safe and effective procedure, with no risk of increasing cerebrovascular complications and vascular shunt application, nor influence on long-term nerve injury. Once carotid artery is ruptured, shunt tube should be used immediately in order to
作者
李晶
蒋京军
张小明
李伟
张学民
李清乐
焦洋
LI Jing;JIANG Jingjun;ZHANG Xiaoming;LI Wei;ZHANG Xuemin;LI Qingle;JIAO Yang(Department of Vascular Surgery,Peking University People's Hospital,Beijing 100044,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2018年第12期1556-1562,共7页
China Journal of General Surgery
关键词
颈动脉体瘤
脑血管循环
转流管
手术后并发症
Carotid Body Tumor
Cerebrovascular Circulation
Shunt Tube
Postoperative Complications
