Reconstruction of internal carotid artery in the resection of paraganglioma of head and neck
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摘要: 目的 探讨在副神经节瘤手术中应用颈内动脉搭桥技术的必要性、手术方法及效果。方法 回顾性研究2015年5月至2023年8月就诊于北京协和医院行头颈部副神经节瘤切除术并行颈内动脉重建术的患者资料，包括人口学特征、术前检查、诊断、术中对颈内动脉的处理技术及术后随访情况。结果 共纳入6例患者，包括女4例，男2例；平均年龄(39.8±13.0)岁；以颈部包块伴或不伴疼痛为主要症状，影像学检查均提示肿瘤完全包绕颈内动脉。4例患者行Fisch颞下窝入路Type A+B、1例Type A、1例经颈侧入路手术。5例以大隐静脉、1例以人工血管重建颈内动脉。平均随访时间为(43.8±31.6)个月。1例患者肿瘤于3年后复发并再次行手术切除，其余5例未见肿瘤复发。1例患者发生急性桥接血管栓塞，另1例桥接血管在随访时发现闭塞。结论 在累及颈内动脉的头颈部副神经节瘤切除手术中行颈动脉搭桥术是彻底切除肿瘤、治愈疾病，同时保证颅内血供、降低脑血管并发症的重要技术。“预重建技术”较常规颈动脉搭桥手术缩短了单次阻断脑血流的时间，一定程度上降低了发生脑血管事件的风险。颈动脉搭桥术后应密切观察患者的临床症状并定期复查影像学检查以评估移植血管的通畅程度及肿瘤残留或复发的情况。Abstract: Objective This study aims to discuss the necessity, surgical method and effect of reconstruction of internal carotid artery (ICA) in the resection of paraganglioma of head and neck.Methods We retrospectively analyzed the data of the patients who underwent head and neck paraganglioma resection and ICA reconstruction in Peking Union Medical College Hospital from May 2015 to August 2023. The demographic characteristics, preoperative examinations, diagnoses, surgical techniques, and follow-up information were collected.Results Six patients were enrolled, including four females and two males, with an average age of(39.8±13.0) years. All the patients presented mainly complaining local masses with or without pain. Four cases underwent surgery through Fisch infratemporal fossa approach type A+B, and one through approach type A and one through transcervical approach. Five patients had vascular reconstruction using the great saphenous vein while one patient used an artificial vessel. The average follow-up period was(43.8±31.6) months. One patient had tumor recurrence after 3 years and underwent second surgery to remove the residual tumor, and the other 5 patients had no tumor recurrence. One patient had acute bridging vessel embolism, and the other was found to have occlusion of the bridging vessel at follow-up.Conclusion Carotid revascularization during resection of paraganglioma of head and neck is an important technique to completely remove the tumor, cure the disease, ensure intracranial blood supply, and reduce cerebrovascular complications. The "pre-reconstruction technique " is an effective method to minimize the duration of brain blood flow interruption, compared to traditional carotid revascularization. Close observation is necessary, along with regular radiological examinations to assess the patency of transplanted vessels, and the residual or recurrent tumors.
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表 1 患者一般资料及手术相关信息
项目 患者1 患者2 患者3 患者4 患者5 患者6 性别 女 男 女 女 男 女 年龄/岁 51 44 55 24 25 40 侧别 L L L L R L 病程/年 10 10 0.8 0.3 0.7 11 诊断 颈动脉体瘤 颈动脉体瘤 颈动脉体瘤 颈静脉孔区
副神经节瘤颈动脉体瘤 颈动脉体瘤 肿瘤大小/cm 10.0×8.0 8.0×7.0 8.0×7.0 4.8×4.1 5.1×2.5 6.5×4.9 肿瘤质地 质韧 质韧 质韧 质硬 质硬 质硬 重建血管 大隐静脉 大隐静脉 大隐静脉 人工血管 大隐静脉 大隐静脉 手术入路 Type A+B Type A+B Type A+B Type A Type A+B 颈侧入路 手术分期 Ⅰ期 Ⅰ期 Ⅰ期 Ⅱ期 Ⅰ期 Ⅰ期 影像学肿瘤与ICA关系 包绕 包绕 包绕 包绕 包绕 包绕 耳蜗 保留 保留 保留 保留 保留 保留 术中面神经 前移 前移 前移 前移 轮廓化 轮廓化 术前面神经功能 Ⅰ Ⅰ Ⅰ Ⅰ Ⅰ Ⅰ 术后面神经功能 Ⅰ Ⅱ Ⅲ Ⅰ Ⅱ Ⅰ 受累后组颅神经 Ⅸ-Ⅻ Ⅻ Ⅸ、Ⅹ Ⅹ-Ⅻ Ⅸ-Ⅻ Ⅸ、Ⅹ、Ⅻ 随访时间/月 36 80 79 48 16 4 重建血管随访结果 通畅 通畅 急性闭塞 迟发性闭塞 通畅 通畅 
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