| Objective:To explore the application value of preoperative carotid angiography for patients with confirmed CBT in assessing the duration of carotid body tumor resection and intraoperative blood loss;to analyze whether carotid angiography can predict surgery for the surgeon before surgery risk provides a reference basis;Thereby improving the safety and effectiveness of carotid body tumor resection,reducing the mortality of patients and improving the quality of life of patients after surgery.Methods:This study selected 102 patients with carotid body tumors(including13 male patients and 89 female patients)who were admitted to the Department of Cardiovascular Surgery of the Affiliated Hospital of Qing Hai University from January2017 to December 2021.All of the above patients met the inclusion criteria and the exclusion criteria,and the diagnosis was confirmed by carotid ultrasound,head and neck CTA,and magnetic resonance.Record the general information(age,gender,height,weight),laboratory data(PLT,PCT,INR,PT,APTT)of all patients in detail,and record tumor data(maximum transverse diameter of tumor,maximum longitudinal diameter of tumor,Shamblin typing);Then according to the"Angiography Group"(this group of patients underwent DSA subventricular carotid angiography within 1 to 2 days before the operation,and recorded the number and source of tumor nourishing vessels)related information of the patients,apply the propensity score matching method(PSM)to match all the"Alternate group"(patients in this group undergoing normal surgical resection without any preoperative intervention)patients with 1:1 matching,and finally obtain a better consistency"Angiography Group"and"Control Group".All tumors were removed by the same surgeon using the same surgical method,and the amount of blood loss and the duration of the operation were collected from the two groups of patients.Organize data and perform statistical analysis,and draw conclusions based on the results of the analysis.Results:The age(mean 51.8±10.0 years old;mean 50.8±11.9 years old),BMI index(mean 25.0±2.5;mean 25.1±3.5)and gender("Angiography Group"2 males and 23 females;"Control Group"3 males and 22 females)of the patients in the"Angiography Group"and the"Control Group"were p>0.05,and there was no statistical difference.In the comparison of blood routine data(the platelet count of the "Angiography Group"was 184.4±62.3×10~9,and the platelet volume was0.213±0.063%;the platelet count of the"Control Group"was 197.4±62.9×10~9,and the platelet volume was 0.229±0.065%),coagulation function data("Angiography Group"activated partial thromboplastin time was 28.7±5.9 seconds,prothrombin time was 10.5±0.9 seconds,the international normalized ratio was 0.872±0.079;"Control Group"activated partial thromboplastin time was 27.0±4.7 seconds,the prothrombin time was 10.4±0.8 seconds,and the international normalized ratio was 0.867±0.073)and tumor data(the maximum transverse diameter of the tumor in the"Angiography Group"was 3.4±0.8 cm,and the maximum longitudinal diameter of the tumor was4.9±1.2 cm.18 cases of Shamblin type II and 7 cases of Shamblin type III;the maximum transverse diameter of the tumor in the"Control Group"was 3.1±1.0 cm,the maximum longitudinal diameter of the tumor is 4.5±1.5 cm,16 cases of Shamblin typeⅡand 9 cases of Shamblin typeⅢ)between the two groups of patients,p>0.05,there is also no statistical difference;The surgical data of the two groups of patients were compared under the premise of comparable baselines,and it was found that patients in the"Angiography Group"had shorter operation time and less intraoperative blood loss than patients in the"Control group"(the difference in operation time was 24.1 minutes,the 95%confidence interval was 11.9-36.3 minutes,p<0.05;the intraoperative blood loss difference was 52.5 ml,and the 95%confidence interval was 0.0-150.0 ml,p<0.05).Data summary and correlation analysis of the angiographic data of the"Angiography Group"showed that most of the nourishing blood vessels of carotid body tumors were derived from the external carotid artery,and the rest were from the internal carotid artery and the external carotid artery.In this study,no nourishing blood vessels were solely derived from the internal carotid artery(among the 25 patients in the"Angiography Group",18 had nourishment vessels from the external carotid artery,accounting for 72%;7 cases had nourishing vessels from both the internal carotid artery and the external carotid artery,accounting for 28%);The diameter of the thickest nourishing artery is correlated with intraoperative blood loss(r=0.895,p<0.05);However,there was no statistical difference in the correlation between the diameter of the thickest nourishing artery and the length of operation(r=0.203,p>0.05),the diameter of the nourishing blood vessels in the tumor will also affect the amount of bleeding during surgery.Conclusion:1.The intraoperative blood loss of CBT resection is related to the diameter of the thickest nourishing artery in the tumor;2.Carotid angiography examination before operation has a certain value for doctors to assess the length of operation and the amount of blood loss during the operation,and can provide a certain reference basis for the surgeon to assess the risk of surgery;3.Most of the nourishing blood vessels of carotid body tumor originate from the external carotid artery,and a few are supplied by the internal carotid artery and the external carotid artery at the same time.Carotid body tumor resection should focus on separating the tumor from the internal carotid artery and external carotid artery,carefully freeing and ligating the feeding artery located between the two blood vessels to provide convenient conditions for subsequent stripping of the upper and lower poles of the tumor. |
PDF Full Text Request