累及颈动脉的复发恶性肿瘤诊治体会

摘要

Objective To study the diagnosis and treatment of the malignant tumor involving carotid artery.Methods A total of 23 cases of recurrent malignant tumors involving the carotid artery were included in this study.For the primary cancers,8 of 23 cases were laryngeal carcinomas,10 hypopharyngeal carcinomas,2 thyroid carcinomas,1 tonsil carcinoma,1 parotid gland carcinoma,and 1 hypopharyngeal sarcoma with the invasion of cervical esophagus.Detailed evaluation on each case was performed before treatment.The relations of recurrent tumors with neck blood vessels were determined with enhanced CT/CTA.Of 23 cases with recurrent malignant tumors involving the carotid artery,16 cases received surgery and 7 cases received the palliative treatment without operation.Results Seven patients with palliative treatments died of hemorrhage from the invaded neck blood vessels,systemic failure or pulmonary metastasis in six months.Of 16 cases with surgery,recurrent tumors were completely excised in 14 cases and there were residual tumor tissues on artery walls in 2 cases.Within 16 surgical cases,2 cases died of neck hemorrhoea after one week because of infection,2 cases died of lung metastasis 8 months later,3 cases died of neck local recurrence 1 year later,2 cases died of lung metastasis after 2 years,1 case died of neck local recurrence 2 years later and 1 case died of a heart attack 2 years later.The rest 5 cases were alive.Conclusions Enhancement CT/CTA can used in the evaluation for recurrent malignant tumors involving the carotid artery.Surgical treatments can be applied to some selected patients,which can improve the quality of life and survival time of the patients.%目的 探讨累及颈动脉的复发恶性肿瘤有效的诊治方法.方法 首先明确肿瘤复发部位是否进行过手术和(或)放射治疗,再根据增强CT和(或)CT血管造影(CT angiography,CTA)评估复发灶与颈总动脉、颈总动脉分叉处以及颈内、外动脉的关系；对于双颈复发病例,需了解复发灶与颈内静脉的关系；对于颈根部复发病例,需评估复发灶与甲状颈干、椎动脉的关系.根据CT和(或)CTA的结果和患者的全身状况确定能否耐受手术,对不同的复发病例进行不同的处理.本组23例累及颈动脉的头颈肿瘤患者中喉癌复发8例,下咽癌复发10例,甲状腺癌复发2例,扁桃体癌复发1例,腮腺癌复发1例,下咽颈段食管肉瘤复发1例.23例患者经术前评估,7例患者行对症(包括止痛)、姑息放疗和化疗,16例行手术治疗.结果 7例姑息治疗患者皆在6个月内死于复发肿瘤出血、全身衰竭或肺部转移.16例手术病例中,14例肿瘤肉眼下完全切除,2例动脉壁上有残留；其中8例术前有颈部疼痛,手术后7例疼痛消失,1例疼痛减轻.2例患者于术后1周因颈部感染大出血死亡,2例手术8个月后死于肺部转移,1年后死于颈部局部复发3例,2年后死于肺部转移2例,死于颈部局部复发和心脏病各1例,其余5例健在.结论 CT和(或)CTA是累及颈动脉的复发恶性肿瘤术前评估的可靠方法,根据CT和(或)CTA部分病例选择地进行手术治疗是可行的,并可延长患者的生存时间,提高其生存质量.