頸動脈小体腫瘍症例における術前栄養血管塞栓術および術後合併症の検討  [in Japanese] Preoperative Embolization and Postoperative Complications of Carotid Body Tumors  [in Japanese]

頸動脈小体腫瘍は, 頸動脈分岐部に発生する比較的まれな腫瘍であり, 手術においては出血のコントロールおよび術後神経障害が問題となる. それゆえ, 術前の栄養血管塞栓術が有用と報告されている. 今回, 頸動脈小体腫瘍手術症例において, 術前栄養血管塞栓術の有効性および術後合併症の検討を行ったので報告する.1990年から2005年までに, 当科にて頸動脈小体腫瘍と診断され手術を施行した6例7側を対象とした. 術前診断としてCT, MRI, 超音波検査, 血管造影検査を行った. 4例5側に術前栄養血管塞栓術を施行した.栄養血管塞栓術施行4例5側では, 術中出血量が平均291mlで, 手術時間が平均4時間55分であった. 非施行2例では, 術中出血量が平均1016mlで, 手術時間が平均10時間17分であった. 脳神経障害を認めた例は一過性も含めると, 舌咽神経麻痺1例, 迷走神経麻痺2例, 舌下神経麻痺4例5側であった. 栄養血管塞栓術施行例では, 術後脳神経障害が出現しても一過性であり, 短期間で改善する傾向がみられた. 両側切除例においてbaroreflex failure syndromeを認めた.栄養血管塞栓術施行例では, 非施行例と比較して術中出血量が少なくなり, 手術時間が短縮する傾向が見られた. また, 術後脳神経障害の程度が軽度であった.

Carotid body tumors are uncommon neoplasms that arise at the bifurcation of the common carotid artery. Surgical resection is generally recommended, but entails an inherent risk of cranial nerves injury and excessive blood loss. Preoperative embolization has been reported to decrease blood loss and shorten resection time. In this study, we analyzed the benefits of preoperative embolization and the postoperative complications when preoperative embolization was performed.Six patients with seven tumors were treated between 1990 and 2005. Each patients preoperative evaluation included CT, MRI, US, and angiography, and preoperative embolization was performed in four patients with five tumors.Blood loss, in the patients who underwent preoperative embolization, ranged from 20 ml to 900 ml (mean: 291ml), and operation time ranged from 4 hours 34 minutes to 6 hours 40 minutes (mean: 4 hours 55 minutes). In the group that did not undergo preoperative embolization, blood loss ranged from 642ml to 1390ml (mean: 1016ml), and operation time ranged from 9 hours 48 minutes to 10 hours 45 minutes (mean: 10 hours 17 minutes).Five patients had postoperative cranial nerve dysfunction, and it involved cranial nerve IX in one patient (14.3%), cranial nerve X in two patients (28.5%), and cranial nerve XII in five patients (71.4%). Resection of bilateral carotid body tumors in one patient resulted in baroreflex failure syndrome.In conclusion, preoperative embolization tends to decrease blood loss and shorten operation time, resulting in lower postoperative neurologic morbidity.