Clinical Analysis Of The Diagnosis And The Surgical Treatments Of 27 Patients With Carotid Body Tumor

Objective: To summarize and analyze the experience of carotid body tumors in diagnosis,surgical treatment and complications.Methods: A retrospective analysis of 27 patients with carotid body tumors who underwent surgical treatment from Oct.2016 to Oct.2018 was taken in Department of Vascular Surgery,Lanzhou University Second Hospital,including auxiliary examination,surgical treatment and postoperative complications.Results: The diagnosis was confirmed before the operation by cervical Bultrasound and cervical CTA/MRA examination.There were 4 males and 23 females in all 27 patients,with a gender ratio of about 1:5.75.There were 15 patients with tumor on the left and 10 on the right,and 2 patients with bilateral carotid body tumor,accounting for 7.41% of the total number of cases.A total of 27 tumors were resected,15 cases on the left side and 12 cases on the right side.The bilateral carotid body tumors were resected to the right side.The postoperative pathological results shows that 25 cases were paraganglioma and 2 cases were schwannomas,consistency rate was 92.59%.Carotid body tumor of one patient is malignant,accounting for 3.70% of the total number of cases.18 patients was simply performed resection of the tumor,7 patients were performed resection of tumors and ligation of external carotid artery after the vascular anastomosis,one patient received the repair of the level of carotid artery bifurcation after the resection of tumor,one patient performed the partial external carotid and internal carotid artery resection and the internal carotid artery and the common carotid artery have made the vascular anastomosis after the resection of tumor.The Shamblin classification was performed in 27 cases after surgical resection,5 cases of classification I,20 cases of classification II,and 2 cases of classification III.No complications occurred in 8 patients.There were 7 patients with affected side numbness and discomfort,7 patients with skewed tongue,2 patients with distortion of commissure,3 patients with hoarse voice,4 patients with the mild cough(the symptoms improved significantly after active treatments).There's 1 patient with left limb hemiplegia,and accompanied with symptoms of nerve paralysis,after active specialized treatment and rehabilitation exercise,the left lower limb muscle strength level recovered to grade 4 and the left upper limb muscle strength level recovered to grade 1.Postoperative follow-up examination was performed in the outpatient department with B-ultrasound or CTA,with a period form 3 months to 2 years.There's no patient lost to follow or death due to surgery and related complications during the follow-up period.2 patients with bilateral carotid body tumors weren't underwent surgical treatment of the left tumor.Conclusion: The initial diagnosis of the carotid body tumor is performed by cervical B-scan ultrasonography,and which were diagnosed by the CTA or MRA.The patients with carotid body tumor should be operated as early as possible,which is an effective preferred treatment method.The Shamblin classification had an impact on the reasonable operation methods,intraoperative blood loss,intraoperative vascular and nerve injury,and postoperative complications.The dissection of external carotid artery during operation has an impact on shortening the operation time and reducing the amount of intraoperative blood loss.Because the benign and malignant tumors cannot be determined preoperatively and intraoperatively,the use of autologous blood transfusion equipment should be cautious.The protection of the brain should be emphasized throughout the whole perioperative period,which is especially during in the operation.