頸動脈體瘤之外科處理

Surgical Treatment of Carotid Body Tumors

許振益(Chen-Yi Hsu) ； 游進益(Chin-Yi Yu)

《中華民國耳鼻喉科醫學會雜誌》 29卷4期 (1994/08) Pp. 287-294

https://doi.org/10.6286/1994.29.4.287

摘要

頸動脈體瘤是一種不常見的頸部腫瘤，其發生的位置在總頸動脈分叉處，經常與鄰近的大血管及腦神經發生黏連；不但手術前後併發症很多，手術時也可能死亡率很高，所以頸動脈體瘤一直是頭頸外科相當棘手的疾病。本科自1982年10月至1993年10月11年間共經歷了8例頸動脈體瘤的病例。其中7例接受手術切除，因為腫瘤黏連而需要切除外頸動脈者有1例，因內頸動脈侵犯而需切除者有2例，其中1例病人接受人工血管(Impra®)重建，另外1例因有良好的側枝循環，並沒有接受血管重建，手術後也沒有發生任何血管性症狀。所有病人手術前都沒有腦神經併發症，而在手術中有2例因腫瘤侵犯迷走神經必須予以切除者，手術後造成聲音嘶啞與嗆食的現象，經過鐵氟龍(teflon)聲帶內注射後，病情皆有明顯改善。另外，有1例病人手術後發生Horner氏症候群，3個月後病情有改善。沒有病人接受放射線或化學治療。手術後病人追蹤的時間為4個月至8年不等，迄今皆沒有復發的現象。

關鍵字

頸動脈體瘤 ； 神經節旁細胞瘤 ； 血管攝影術

並列摘要

Carotid body tumor is an uncommon tumor of the head and neck region. It originates from neural crest paraganglion cells at the carotid bifurcation. Almost 75% of carotid body paragangliomas adhere to or surround the adjacent arteries and cranial nerves. Their resection can result in neurovascular injury, stroke and excessive blood loss. The postoperative complications and mortality still remain as a great problem. So the diagnosis and treatment of carotid body paragangliomas continue to be a big challenge to the head and neck surgeons.
There were 8 cases of carotid body paragangliomas treated at the TCVGH from October 1982 to October 1993. Seven of them received total excision of tumor mass. External carotid artery ligation was made due to tumor invasion in 1 case. Internal carotid artery resection was done due to extensive tumor adhesion in 2 cases. One of them received carotid artery bypass with cortex reconstruction. The other one had good collateral circulation and thus precluded carotid reconstruction. No storke or hemiplegia was noted postoperatively.
Resection of the vagus nerve was done on 2 cases due to tumor invasion of the nerve noted during surgery. The hoarseness and choking of these 2 cases were much improved after teflon intracordal injection. One case had Horner's syndrome after operation but improved 3 months later. No patient received radiotherapy or chemotherapy. No recurrence was noted for all cases from 4 months to 8 years after surgery. We suggest surgery is the treatment of choice for carotid body tumor in case the clinical symptoms are evident.

並列關鍵字

carotid body tumor ； paraganglioma ； angiography