双极电凝镊应用于治疗Shamblin Ⅲ 型颈动脉体瘤6例

doi:10.6040/j.issn.1673-3770.0.2024.272

摘要/Abstract

摘要： 目的探讨双极电凝镊在 Shamblin Ⅲ 型颈动脉体瘤(carotid body tumor,CBT)外科治疗中的应用价值。方法回顾性分析12 例Shamblin Ⅲ型患者临床数据资料,所有患者均接受包括颈部B超、计算机断层扫描血管造影术(computed tomography angiography, CTA)、磁共振成像(magnetic resonance imaging, MRI)和数字减影血管造影(digital subtraction angiography, DSA)的术前评估。将12例分为对照组(6例)和观察组(6例),对照组采用传统手术切除,观察组使用双极电凝镊辅助手术。所有手术均由同一组手术医师完成,对比两组术中相关指标、术后并发症发生率等差异。结果双极电凝镊手术组的术中出血量明显低于传统手术组(298 mL比633 mL),手术时间也短于传统手术组(201 min比326 min)。术后并发症发生率在手术组(16.7%)明显低于对照组(100.0%),差异具有统计学意义(P<0.05)。结论在完善的术前评估及合理的手术方案的基础上,双极电凝镊辅助Shamblin Ⅲ型颈动脉体瘤切除术可以减少出血量、缩短手术时间、减少术后并发症,手术安全性显著提高。

关键词: 颈动脉体瘤, Shamblin 分型, 双极电凝, 颅神经损伤, 术中出血

Abstract: Objective The study aims to evaluate the utility of bipolar electrocoagulation forceps in the surgical management of Shamblin III carotid body tumours(CBT). Methods A retrospective analysis of the clinical data of 12 patients with Shamblin III type tumours treated at our hospital was performed. All patients underwent preoperative evaluation including neck ultrasound, Computed Tomography Angiography(CTA), Magnetic Resonance Imaging(MRI), and Digital Subtraction Angiography(DSA). The study was divided into a control group and an observation group. The control group underwent traditional surgical resection, while the observation group used bipolar electrocoagulation forceps as an adjunct to surgery. All operations were performed by the same team of surgeons. Differences between the two groups in intraoperative indicators and postoperative complication rates were compared. Results The intraoperative blood loss in the bipolar coagulation forceps group was significantly lower than that in the traditional surgery group(298 mL vs. 633 mL), and the surgical time was also notably shorter in the bipolar coagulation group(201 minutes vs. 326 minutes). The incidence of postoperative complications in the surgical group(16.7%)was significantly lower than that in the control group(100.0%), with a statistically significant difference(P<0.05). Conclusion With comprehensive preoperative evaluation and a rational surgical plan, the use of bipolar electrocoagulation forceps to assist in the resection of Shamblin Ⅲ-type carotid body tumours can reduce blood loss, shorten operation time, and decrease postoperative complications, thereby significantly improving surgical safety.

Key words: carotid body tumor, Shamblin classification, bipolar electrocoagulation, cranial nerve injury, intraoperative hemorrhage

中图分类号:

R739.91

曾琪璎,朱华明,关建,吴红敏,叶海波,易红良. 双极电凝镊应用于治疗Shamblin Ⅲ 型颈动脉体瘤6例[J]. 山东大学耳鼻喉眼学报, 2025, 39(3): 70-76.

ZENG Qiying, ZHU Huaming, GUAN Jian, WU Hongmin, YE Haibo, YI Hongliang. Bipolar coagulation forceps applied in the treatment of 6 cases of shamblin type III carotid body tumors[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(3): 70-76.

参考文献

[1] Robertson V, Poli F, Hobson B, et al. A systematic review and meta-analysis of the presentation and surgical management of patients with carotid body tumours[J]. Eur J Vasc Endovasc Surg, 2019, 57(4): 477-486. doi:10.1016/j.ejvs.2018.10.038
[2] Hoang VT, Trinh CT, Lai TAK, et al. Carotid body tumor: a case report and literature review[J]. J Radiol Case Rep, 2019, 13(8): 19-30. doi:10.3941/jrcr.v13i8.3681
[3] 中国微循环学会周围血管疾病专业委员会. 颈动脉体瘤外科手术规范专家共识[J]. 血管与腔内血管外科杂志, 2023, 9(3): 257-264. doi:10.19418/j.cnki.issn2096-0646.2023.03.01
[4] Melachuri S, Valappil B, Snyderman C. Variations in surgical outcomes of carotid body tumors by surgical specialty[J]. Laryngoscope, 2021,131(1): 190-195. doi:10.1002/lary.28688
[5] Fathalla AE, Elalfy MA. Clinical outcome of carotid body paraganglioma management: a review of 10-year experience[J]. J Oncol, 2020, 2020: 6081273. doi:10.1155/2020/6081273
[6] Chen YJ, Li YZ, Liu JL, et al. The clinical characteristics and outcomes of carotid body tumors in Chinese patients: a STROBE-compliant observational study[J]. Medicine, 2020, 99(3): e18824. doi:10.1097/MD.0000000000018824
[7] 王莹莹, 张立庆, 周涵, 等. 74例鳃裂囊肿及瘘管临床分析 [J]. 山东大学耳鼻喉眼学报, 2020, 34(4): 111-116. doi:10.6040/i.issn.1673-3770.0.2019.523 WANG Yingying, ZHANG Liqing, ZHOU Han, et al. Clinical analysis of 74 cases of branchial cleft cysts and fistulas [J].Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(4): 111-116. doi:10.6040/i.issn.1673-3770.0.2019.523
[8] Jasper A, Mammen S, Gowri MS, et al. Imaging criteria to predict Shamblin Group in carotid body tumors- revisited[J]. Diagn Interv Radiol, 2021, 27(3): 354-359. doi:10.5152/dir.2021.20028
[9] Shamblin WR, ReMine WH, Sheps SG, et al. Carotid body tumor(chemodectoma). Clinicopathologic analysis of ninety cases[J]. Am J Surg, 1971, 122(6): 732-739. doi:10.1016/0002-9610(71)90436-3
[10] Li N, Yang RM, Chang GQ, et al. Preoperative embolization is necessary for large-volume carotid body tumor(≥6 670 mm³)resection[J]. Eur Arch Otorhinolaryngol, 2023, 280(9): 4177-4183. doi:10.1007/s00405-023-07990-2
[11] 孔祥国, 李楠. Shamblin Ⅱ/Ⅲ型颈动脉体瘤经导管动脉栓塞后外科手术切除的时机选择:24小时内最佳 [J]. 临床放射学杂志, 2022, 41(2): 330-334 KONG Xiangguo, LI Nan. Effective within 24 Hours Preoperative Embolization and Surgical Resection of Shamblin Ⅱ/Ⅲ Carotid Body Tumors[J]. Journal of Clinical Radiology, 2022, 41(2): 330-334
[12] Huang P, Bao HE, Zhang L, et al. Surgical treatments and diagnosis of the carotid-body tumor[J]. Asian J Surg, 2023, 46(2): 941-942. doi:10.1016/j.asjsur.2022.07.068
[13] Li X, Zhang WC, Shu C, et al. Diagnosis and outcomes of surgical treatment of carotid bifurcation tumors[J]. J Int Med Res, 2020, 48(12): 300060520976495. doi:10.1177/0300060520976495
[14] 朱江, 魏小龙, 秦锋, 等. 80例颈动脉体瘤的外科治疗[J]. 中华普通外科杂志, 2017, 32(2): 126-128. doi:10.3760/cma.j.issn.1007-631X.2017.02.010 ZHU Jiang, WEI Xiaolong, QIN Feng, et al. Surgical treatment of carotid body tumor in 80 patients[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2017, 32(2): 126-128. doi:10.3760/cma.j.issn.1007-631X.2017.02.010
[15] Sevil FC. Management and outcomes of vascular reconstruction in carotid body tumor resection: retrospective analysis of 60 cases[J]. Eur Arch Otorhinolaryngol, 2020, 277(8): 2299-2306. doi:10.1007/s00405-020-05975-z
[16] Davila VJ, Chang JM, Stone WM, et al. Current surgical management of carotid body tumors[J]. J Vasc Surg, 2016, 64(6): 1703-1710. doi:10.1016/j.jvs.2016.05.076
[17] Illuminati G, Pasqua R, Nardi P, et al. Results of resection of carotid body tumors with and without lymphnodes' dissection[J]. Surg Oncol, 2021, 37: 101555. doi:10.1016/j.suronc.2021.101555
[18] 李平栋, 于振坤, 房居高, 等. 颈动脉体瘤诊断与处理-单中心经验[J]. 首都医科大学学报, 2012, 33(6): 757-761. doi:10.3969/j.issn.1006-7795.2012.06.010 LI Pingdong, YU Zhenkun, FANG Jugao, et al. Diagnosis and surgical treatment of carotid body tumor: a single clinical center experience[J]. Journal of Capital Medical University, 2012, 33(6): 757-761. doi:10.3969/j.issn.1006-7795.2012.06.010
[19] Kim GY, Lawrence PF, Moridzadeh RS, et al. New predictors of complications in carotid body tumor resection[J]. J Vasc Surg, 2017, 65(6): 1673-1679. doi:10.1016/j.jvs.2016.12.124
[20] Riopelle AM, Potter CT, Jeong D, et al. Plume generated by different electrosurgical techniques: an in vitro experiment on human skin[J]. Dermatol Surg, 2022, 48(9): 949-953. doi:10.1097/DSS.0000000000003518
[21] 任芳芳, 王章锋. 支撑喉镜下双极电凝联合平阳霉素注射治疗咽喉部血管瘤的疗效[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(10): 938-940. doi:10.13201/j.issn.2096-7993.2021.10.016 REN Fangfang, WANG Zhangfeng. Therapeutic effect of bipolar electrocoagulation combined with pingyangmycin injection for pharyngeal hemangioma under suspension laryngoscope[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2021, 35(10): 938-940. doi:10.13201/j.issn.2096-7993.2021.10.016

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed