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目的 利用球囊暂时性阻断技术结合SPECT(SinglePhotonEmissionComputedTomography)术前评价颈内动脉可能在术中切除的头颈部肿瘤患者对颈动脉切除后的耐受程度。方法 2 7例术中可能切除颈动脉的头颈部肿瘤患者 ,经股动脉导入双腔球囊导管 ,达到患侧分叉以上的颈内动脉或颈总动脉时 ,注射造影剂充盈球囊阻断颈动脉 45min。观察并记录球囊阻断前后的神经系统的变化。在球囊阻断后 3 0min ,静脉内注射 2 5ml99mTe ECD进行SPECT的扫描。结果 2 7例进行颈动脉阻断评价的头颈部肿瘤患者 ,17例阴性 ,10例阳性。阳性病例表现为神经功能障碍以及在SPECT上脑血流灌注不足。基于此评价 ,该组阳性病例术中 8例行肿瘤及所及颈动脉切除的同时行人造血管重建颈动脉 ;7例术中切除了肿瘤及所及颈动脉 ,未行颈动脉重建 ;12例术中将肿瘤与颈动脉分离。切除或重建颈动脉的患者手术后均未出现明显的神经功能障碍。结论 利用球囊暂时性阻断技术结合SPECT可以对颈内动脉可能在术中切除的头颈部肿瘤患者进行术前实验评价 ,以掌握其对颈动脉切除后的耐受程度。该评价不仅具有诊断价值 ,还对治疗方案的制定具有直接的指导意义
Objective To evaluate the degree of tolerance of carotid artery resection in patients with head and neck neoplasms whose internal carotid artery might be removed during operation preoperatively using SPECT (Single Photon Emission Computed Tomography). Methods Twenty-seven patients with head and neck neoplasms who may have resection of the carotid artery were introduced into the double-lumen balloon catheter through the femoral artery. When the internal carotid artery or the common carotid artery above the bifurcation of the affected side was reached, the injection of contrast agent filled the balloon stenosis. Broken carotid artery 45min. Observe and record changes in the nervous system before and after balloon occlusion. At 30 min after balloon occlusion, SPECT was scanned intravenously with 25 ml of 99mTe ECD. Results Twenty-seven patients with head and neck cancer assessed by carotid artery occlusion were negative in 17 cases and positive in 10 cases. Positive cases manifested as neurological dysfunction and insufficient cerebral blood perfusion on SPECT. Based on this assessment, 8 cases of this group of positive cases underwent the reconstruction of the carotid artery with an intra-arterial vascular resection at the time of tumor and carotid resection; 7 cases had resection of the tumor and carotid artery and no reconstruction of the carotid artery during operation; 12 cases The tumor was separated from the carotid artery during surgery. Patients with resection or reconstruction of the carotid artery had no significant neurological deficits after surgery. Conclusion The use of temporary balloon occlusion combined with SPECT can be used to evaluate the preoperative evaluation of patients with internal carotid artery may be resection of head and neck tumors in order to determine their tolerance to carotid artery resection. This evaluation not only has diagnostic value, but also has direct guiding significance for the formulation of treatment plans.