Current surgical management of carotid body tumors
Current surgical management of carotid body tumors
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DOI：
10.1016/j.jvs.2016.05.076
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发表时间：
2016-12-01
影响因子：
4.3
通讯作者：
Money, Samuel R.
中科院分区：
文献类型：
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作者：
Davila, Victor J.;Chang, James M.;Money, Samuel R.
背景：颈动脉体瘤是一种罕见的肿瘤。管理指南可能包括琥珀酸脱氢酶(SDH)突变的基因检测。我们对CBT的外科治疗进行了机构回顾。方法：对1994-2015年间在我们机构接受CBT切除的病例进行回顾性分析。获得的数据包括人口统计学、基因测试(如果进行)、术中细节、术后发病率和长期结果。来自第一次CBT切除的数据包括在双侧肿瘤患者中。对有CBT家族史或多发性副神经节瘤的患者常规进行基因检测。结果：共切除了183例CBT，其中124名女性(67.7%)。颈部肿块106例(57.9%)，压痛或颈部疼痛24例(12.1%)，颅神经功能障碍3例(1.6%)。计算机断层扫描(57.9%)或磁共振成像(51.3%)是最常用的成像方式。73例患者(39.8%)进行了术前血管造影术，其中62例(84.5%)接受了栓塞术和/或颈内动脉球囊闭塞试验。肿瘤平均直径3.2 cm(0.67.2 cm)。Shamblin 1型71例(38.8%)，Shamblin 2例75例(41%)，Shamblin 2例37例(20.2%)。平均手术时间224分钟(52~696分钟)。术中平均出血量143.9毫升(10~2000毫升)。10例患者需要用间置移植物进行动脉重建，4例患者接受了补片血管成形术。脑神经永久性损伤10例(5.5%)，卒中发生率1%(n=2)。共切除382个淋巴结，均为良性。没有人死亡。
Background: Carotid body tumors (CBTs) are rare. Management guidelines may include genetic testing for succinate dehydrogenase (SDH) mutations. We performed an institutional review of the surgical management of CBT.Methods: A retrospective analysis (1994-2015) of CBT excisions at our institution was performed. Data obtained included demographics, genetic testing (if performed), intraoperative details, postoperative morbidity, and long-term outcomes. Data from the first CBT excision were included in patients with bilateral tumors. Genetic testing was routinely offered in patients with a family history of CBT or multiple paragangliomas.Results: A total of 183 CBTs (124 female [67.7%]) were excised. A neck mass was present in 106 patients (57.9%), 24 patients (12.1%) presented with tenderness or neck pain, and 3 (1.6%) presented with cranial nerve dysfunction. Computed tomography (57.9%) or magnetic resonance imaging (51.3%) were the most commonly used imaging modalities. Preoperative angiography was performed in 73 patients (39.8%), and 62 of them (84.5%) underwent embolization or internal carotid balloon occlusion testing, or both. Mean tumor diameter was 3.2 cm (range, 0.67.2 cm). There were 71 (38.8%), 75 (41%), and 37 (20.2%) Shamblin type 1, 2, and 3 tumors, respectively. Average operating time was 224 minutes (range, 52-696 minutes). Average blood loss was 143.9 mL (range, 10-2000 mL). Arterial reconstruction with an interposition graft was required in 10, and patch angioplasty was performed in four. Cranial nerve injurywas permanent in 10 (5.5%), and the rate of stroke was 1%(n = 2). A total of 382 lymph nodes were excised, and all were benign. There were no deaths