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浙江大学学报（医学版）
浙江大学学报（医学版）  2018, Vol. 47 Issue (6): 583-587    DOI: 10.3785/j.issn.1008-9292.2018.12.03
专题报道     
颈总动脉分叉部神经鞘瘤与颈动脉体瘤患者外科治疗分析
邵华1(),刘斐2,张薇2,王利新2,*(),陈斌2,蒋俊豪2,董智慧2,石赟2,郭大乔2,符伟国2
1. 大连大学附属新华医院血管外科, 辽宁 大连 116021
2. 复旦大学附属中山医院血管外科, 上海 200032
Clinical features and surgical treatment of neurilemmoma versus carotid body tumors at bifurcation of carotid artery
SHAO Hua1(),LIU Fei2,ZHANG Wei2,WANG Lixin2,*(),CHEN Bin2,JIANG Junhao2,DONG Zhihui2,SHI Yun2,GUO Daqiao2,FU Weiguo2
1. Department of Vascular Surgery, Dalian University Affiliated Xinhua Hospital, Dalian 116021, Liaoning Province, China
2. Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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摘要：

目的: 对比分析颈总动脉分叉部神经鞘瘤与颈动脉体瘤的临床特点、治疗方法及术后转归。方法: 回顾性分析2012年3月至2016年11月复旦大学附属中山医院血管外科治疗的17例颈总动脉分叉部神经鞘瘤（神经鞘瘤组）和76例颈动脉体瘤（颈动脉体瘤组）患者的临床资料，对比分析两组患者的临床和病理特点、手术情况及随访结果。结果: 两组临床特征相似。神经鞘瘤组手术时间较短[（94±31）min比（159±53）min，P < 0.01]，术中出血量较少[（110±96）mL比（356±239）mL，P < 0.01]，需要切除颈外动脉概率较小（11.8%比68.4%，P < 0.01）。两组患者均完整切除肿瘤。神经鞘瘤组无恶性病变，颈动脉体瘤组恶性病变5例（6.6%）。神经鞘瘤组的肿瘤直径较颈动脉体瘤组大[（4.5±1.4）cm比（3.1±1.0）cm，P < 0.01]。两组围手术期并发症发生率及住院时间差异均无统计学意义（均P>0.05）。结论: 颈动脉分叉部神经鞘瘤与颈动脉体瘤患者术前临床表现类似，但颈动脉体瘤患者手术时间较长、术中出血量较大，颈外动脉切除率较高，瘤体恶性病变的概率较高，临床处理时应给予更多关注。
关键词： 颈总动脉/外科学;  神经鞘瘤;  颈动脉体瘤;  磁共振成像;  体层摄影术, X线计算机;  血管造影术, 数字减影;  诊断, 鉴别    
Abstract:

Objective: To analyze clinical features, surgical treatment and outcomes of neurilemmoma and carotid body tumors in bifurcation of carotid artery. Methods: The clinical data of 17 patients with neurilemmomas and 76 patients with carotid body tumors at the bifurcation of carotid artery, who were surgically treated in Zhongshan Hospital of Fudan University from March 2012 to November 2016, were retrospectively analyzed. The clinicopathological characteristics, surgical procedures and outcomes were compared between two groups. Results: No difference of preoperative clinical demographic data was found between two groups. Operation time of the neurilemmoma group was significantly shorter than that of the carotid body tumor group[(93.9±30.8) min vs. (159.3±52.9) min, P < 0.01]. The neurilemmoma group had lower volume of intra-operative blood loss[(110±96) mL vs. (356±239) mL, P < 0.01] and lower rate of external carotid artery resection (11.8% vs. 68.4%, P < 0.01) than the carotid body tumor group. In the neurilemmoma group, 17 tumors were completely resected and no malignant disease was found. In the carotid body tumor group, 76 patients underwent complete surgical resection for the tumor, of which 5 (6.6%) were malignant. Tumor size of the neurilemmoma group was larger than that of the carotid body tumor group[(4.5±1.4) cm vs. (3.1±1.0) cm, P < 0.01]. There was no significant difference in the incidence of peri-operative complications and length of hospital stay between two groups (P>0.05). Conclusions: The clinical manifestations of neurilemmoma and carotid body tumors at carotid artery bifurcation are similar. The carotid body tumor group has a longer operating time, larger intra-operative blood loss, higher external carotid resection rate and relative higher incidence of malignancy. More cautions should be given when carotid body tumors at carotid artery bifurcation are treated.
Key words: Carotid artery, common/surgery    Neurilemmoma    Carotid body tumor    Magnetic resonance imaging    Tomography, X-ray computed    Angiography, digital subtraction    Diagnosis, differential
收稿日期: 2018-08-14 出版日期: 2019-03-15
:  R65  
基金资助: 国家自然科学基金(81770508)
通讯作者: 王利新     E-mail: 174799575@qq.com;wang.lixin@zs-hospital.sh.cn
作者简介: 邵华(1983-), 男, 学士, 主治医师, 主要从事血管外科疾病的诊治研究; E-mail:174799575@qq.com; https://orcid.org/0000-0001-9125-3086
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邵华
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张薇
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董智慧
石赟
郭大乔
符伟国

引用本文:

邵华,刘斐,张薇,王利新,陈斌,蒋俊豪,董智慧,石赟,郭大乔,符伟国. 颈总动脉分叉部神经鞘瘤与颈动脉体瘤患者外科治疗分析[J]. 浙江大学学报（医学版）, 2018, 47(6): 583-587.

SHAO Hua,LIU Fei,ZHANG Wei,WANG Lixin,CHEN Bin,JIANG Junhao,DONG Zhihui,SHI Yun,GUO Daqiao,FU Weiguo. Clinical features and surgical treatment of neurilemmoma versus carotid body tumors at bifurcation of carotid artery. J Zhejiang Univ (Med Sci), 2018, 47(6): 583-587.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2018.12.03    或    http://www.zjujournals.com/med/CN/Y2018/V47/I6/583

[$\bar x \pm s$或n(%)]
组别 n 性别(男/女) 年龄(岁) 病程(月) 家族史 病变位置(左/右/双侧) 触及肿物 压痛 头晕 声音嘶哑 合并症
高血压 糖尿病 冠心病
—:无相关数据.
神经鞘瘤组 17 5/12 41±15 10±12 0(0.0) 6/11/0 16(94.1) 2(12.5) 1(5.9) 0(0.0) 4(23.5) 1(5.9) 0(0.0)
颈动脉体瘤组 76 28/48 43±13 25±41 1(1.3) 35/31/10 73(96.1) 5(6.8) 2(2.6) 1(1.3) 22(28.9) 4(5.3) 5(6.8)
χ2/t值 — 0.335 0.533 1.468 0.226 4.361 0.126 0.537 0.470 0.226 0.202 0.010 1.182
P值 — ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05
表 1  患者基线资料比较
[$\bar x \pm s$或n(%)]
组别 n 手术时间(min) 出血量(mL) 切除颈外动脉 住院时间(d) 术后并发症 肿瘤直径(cm) 恶性肿瘤
—：无相关数据.
神经鞘瘤组 17 94±31 110±96 2(11.8) 10±5 9(52.9) 4.5±1.4 0(0.0)
颈动脉体瘤组 76 159±53 356±239 52(68.4) 11±5 31(40.8) 3.1±1.0 5(6.6)
χ2/t值 — -6.803 -6.811 21.506 -1.154 0.837 3.925 1.182
P值 — ＜0.01 ＜0.01 ＜0.01 ＞0.05 ＞0.05 ＜0.01 ＞0.05
表 2  两组手术情况及临床病理特点比较
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