[Experience of successful rescue from 5 cases of internal carotid artery injury during transnasal endoscopic skull base surgery].
[Experience of successful rescue from 5 cases of internal carotid artery injury during transnasal endoscopic skull base surgery].
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DOI：
10.3760/cma.j.issn.1673-0860.2018.04.003
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发表时间：
2018-04-07
影响因子：
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通讯作者：
Zhao, W
中科院分区：
文献类型：
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作者：
Yin, F;Sun, J W;Zhao, W
目的：探讨鼻内镜下颅底手术中颈内动脉损伤的原因及急诊处理。研究方法：回顾性分析2010年12月至2017年7月在中国科学技术大学第一附属医院耳鼻咽喉头颈外科行经鼻内镜颅底手术时遇到的5例颈内动脉损伤病例。其中腺样囊性癌2例，涎腺型腺癌1例，岩尖胆固醇肉芽肿1例，鳞癌1例。分析了经鼻内镜手术中颈内动脉损伤的原因及处理方法，以预防颈内动脉损伤。结果：5例患者术中均成功填塞凡士林条。2例行血管内覆膜支架植入术; 1例行肌筋膜替代填塞术; 1例行鼻腔及鼻咽腔凡士林条填塞术; 1例鼻腔填塞失败后行颈总动脉结扎术。4例成功治疗，无颅脑或眼部并发症。1例结扎后出现肢体瘫痪。随访6 ~ 84个月，无死亡病例。结论：颈内动脉损伤与手术操作不当、解剖定位不当有关，应及时止血，并由经验丰富的多学科团队修复血管损伤。
Objective: To investigate the cause and urgent management of internal carotid artery injury during transnasal endoscopic skull base surgery. Methods: Five cases of internal carotid artery injury encountered during transnasal endoscopic skull base surgery in Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of University of Science of Technology of China, Anhui Provincial Hospital from December 2010 to July 2017 were analysed retrospectively. There were 2 cases of adenoid cystic carcinoma, 1 case of salivary gland-type adenocarcinoma, 1 case of petrous apex cholesterol granulomas and 1 case of squamous carcinoma. The cause of internal carotid artery injury and subsequent treatment were analysed, in order to prevent internal carotid artery injury during transnasal endoscopic surgery. Results: Intraoperatively, all these 5 cases were packed with vaseline strip successfully. Two cases underwent subsequent intravascular covered stent graft implantation; 1 case underwent replacement of packing with muscle fascia graft; 1 case was packed with vaseline strip in nasal and nasopharyngeal cavity; 1 case accepted ligation of common carotid artery after failure of nasal packing. Four cases were successfully treated without craniocerebral or ocular complications. Otherwise, 1 case demonstrated with extremity paralysis after ligation. Follow up ranged from 6 to 84 months, no patient died. Conclusion: The injury of internal carotid artery is related with improper operative procedures and anatomic localization, which should be treated properly with emergent hemostasis, and an experienced multidisciplinary team to repair vascular damage is very important.