背景:颈动脉体副神经节瘤(CBP)是一种罕见的,高度血管化,和生长缓慢的神经内分泌肿瘤.手术切除是CBP的决定性治疗,然而,由于肿瘤靠近关键血管和颈神经,它仍然具有挑战性。本研究旨在记录CBP的特征,并检查CBP手术切除后患者的临床结局。
方法:这是一项单中心回顾性研究,分析了接受CBP摘除的患者。我们检查了病人的人口统计,术前临床特征,肿瘤特征,血清和尿液中儿茶酚胺及其代谢物的水平。由一名血管外科医生进行手术,并在1、3、6个月和此后每年进行随访。进行Logistic回归分析以确定与永久性或暂时性宫颈颅神经麻痹(CNP)发生相关的危险因素。
结果:从2020年9月至2023年2月,本研究检查了19例患者中进行的21例CBP去除手术。患者的平均年龄为38.9±10.9岁,男性的百分比为57.1%(n=12)。术前最常见的临床特征是无痛性颈部肿块(n=12;57.1%)。20例完全切除;不包括1例经病理证实的硬化性副神经节瘤。4例进行了血管手术(ECA切除术,n=2;无颈动脉分流的ICA撕裂的初次修复,n=1;ICA补片血管成形术伴颈动脉分流,n=1)。暂时性颅神经并发症,特别是误吸和声音嘶哑发生在四个(19.0%),和三例(14.3%),分别。在2例(9.5%)中,与永久性CNP相关的声音嘶哑持续超过6个月。随访期间未见复发或死亡。
结论:手术切除是CBP的首选治疗方法;然而,它会带来血管或宫颈CNP的风险。术中估计的失血是CNP的唯一确定的危险因素。
BACKGROUND: Carotid body paraganglioma (CBP) is a rare, highly vascularized, and slow-growing neuroendocrine tumor. Surgical resection is the definitive treatment for CBP, however, it remains challenging due to the tumor\'s proximity to critical blood vessels and cervical cranial nerves. This study aimed to document the characteristics of CBP and examine the clinical outcomes of patients following surgical extirpation of CBP.
METHODS: This is a single-center retrospective review analyzed patients who underwent CBP extirpation. We examined the patient demographics, preoperative clinical features, tumor characteristics, levels of catecholamines and their metabolites in the serum and urine. Surgeries were performed by one vascular surgeon with follow-ups at 1,3,6 months and yearly thereafter. Logistic regression analysis was conducted to identify risk factors associated with the occurrence of either permanent or temporary cervival cranial nerve palsy (CNP).
RESULTS: From September 2020 to February 2023, this study examined 21 cases of CBP removal surgeries that were carried out in 19 patients. The mean age of the patients was 38.9 ± 10.9 years and the percentage of males was 57.1% (n = 12). The most common preoperative clinical feature was painless neck mass (n = 12; 57.1%). Complete resection was achieved in 20 cases; excluding one case with pathologically proven sclerosing paraganglioma. Vascular procedures were performed in four cases (ECA resection, n = 2; primary repair of ICA tear without carotid shunting, n = 1; and ICA patch angioplasty with carotid shunting, n = 1). Temporary cranial neurologic complications, specifically aspiration and hoarseness occurred in four (19.0%), and three (14.3%) cases, respectively. Hoarseness associated with permanent CNP persisted for more than 6 months in two cases (9.5%). No recurrence or mortality was observed during the follow-up period.
CONCLUSIONS: Surgical resection is the primay treatment approach for CBP; however, it poses risks of vascular or cervical CNP. The intraoperative estimated blood loss was the only identified risk factor for CNP.