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目的:探讨在头颈肿瘤累及颈动脉近颅段的外科根治中术前应用永久性球囊阻断技术的价值。方法:2002年3月-2005年12月,对10例术前成功耐受暂时性球囊阻断(TBO)试验的头颈部肿瘤侵犯高位颈动脉患者,行颈内动脉永久球囊阻断(PBO),并于PBO术后2～14d内行颅颌联合根治术(3例)、颅外扩大根治术(7例);术后缺损区行远位或邻近组织瓣修复,其中游离背阔肌皮瓣4例、带蒂胸大肌皮瓣3例、颞肌筋膜组织瓣1例、邻近组织瓣2例。结果:10例患者术前均成功耐受TBO,其残端动脉压(SP)≥50mmHg,均值为61.4mmHg。10例患者行颈内动脉PBO术后,1例于阻断后24h内出现脑梗死症状,经对症治疗后症状明显改善;2例患者于阻断后24～48h内出现短暂脑缺血症状;其余7例患者阻断后均无脑供血不足表现。10例肿瘤均完整切除,所有移植组织瓣移植均存活,伤口一期愈合。10例患者手术后非阻断侧上、下肢体肌力评价9例均为5级;另1例上肢为4级,下肢为5级。10例患者随访6～24个月,未见肿瘤复发,无颅神经症状。结论:对于头颈肿瘤累及高位颈动脉的患者,采用颈内动脉颅内段永久性球囊阻断技术,不仅能有效控制出血,而且能简化手术,降低风险,并安全地实施肿瘤根治性切除。
Objective: To investigate the value of preoperative application of permanent balloon occlusion in surgical radical mastectomy of head and neck tumors involving the proximal cranial segments of carotid arteries. Methods: From March 2002 to December 2005, 10 patients with head and neck cancer who had successfully undergone the preoperative TBO test were inflicted with high carotid artery and were given permanent balloon occlusion of the internal carotid artery (PBO), and craniotomy combined radical mastectomy (3 cases) and extracranial extension radical mastectomy (7 cases) within 2 ~ 14 days after PBO. 4 cases of myocutaneous flap, 3 cases of pedunculated pectoralis major myocutaneous flap, 1 case of temporal fascia tissue flap and 2 adjacent tissue flap. Results: All 10 patients were successfully tolerated TBO before operation. The stump arterial pressure (SP) was 50 mmHg and the mean was 61.4 mmHg. Ten patients underwent internal carotid artery PBO. One patient had symptoms of cerebral infarction within 24 h after occlusion. Symptoms were significantly improved after symptomatic treatment. Two patients had transient ischemic symptoms within 24-48 h after occlusion. The remaining 7 patients showed no cerebral insufficiency after blocking. Ten cases of tumor were completely resected, all transplanted tissue flap all survived, wound healing. Ten patients were non-occluded lateral and lower limb muscle strength evaluation of 9 cases were 5; the other 1 case of upper limbs 4, 5 lower limbs. Ten patients were followed up for 6 to 24 months, no tumor recurrence, no cranial nerve symptoms. CONCLUSIONS: In patients with head and neck cancer involving the high carotid artery, the intracranial intracranial intracranial permanent balloon occlusion technique can not only effectively control the bleeding, but also simplify the operation, reduce the risk and safely perform the radical tumor resection.