河北医科大学学报

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覆膜支架联合手术治疗头颈部癌侵犯颈动脉在绵羊模型中的试验性研究

  

  1. 河北医科大学第四医院耳鼻咽喉-头颈外科,河北 石家庄 050011
  • 出版日期:2020-06-25 发布日期:2020-06-29
  • 作者简介:赵珍(1982-),男,河北无极人,河北医科大学第四医院主治医师,医学硕士,从事耳鼻喉科疾病诊治研究。
  • 基金资助:
    河北省科技计划项目(13277792D)

An experimental study of covered stent combining with surgery in the treatment of head and neck cancer invading carotid artery in sheep model#br#

  1. Department of Otolaryngology-Head and Neck Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
  • Online:2020-06-25 Published:2020-06-29

摘要: 目的 通过在绵羊颈动脉模型中预置覆膜支架于局部假定受侵颈动脉处,手术切除受侵犯血管,探讨覆膜支架联合手术治疗头颈部癌侵犯颈动脉的可行性。
方法 选取10只健康绵羊的颈动脉,通过髂总动脉将覆膜支架置入假定受侵颈动脉处,手术切开支架所覆盖的颈动脉区域,切除覆膜支架覆盖的部分动脉壁,观察术区有无出血及支架松动。通过影像观察术区有无出血、外漏及支架的扭曲、松脱及移位,记录实验动物的意识、活动等。
结果 局部无渗血,除1例支架植入后扭曲,其余9例覆膜支架均释放成功,技术成功率为90%。术中无并发症发生。手术成功切除覆膜支架覆盖的全周动脉壁,术中观察支架固定良好。术后绵羊生命体征平稳,无偏瘫、四肢活动障碍等并发症,覆膜支架区域无出血及肿胀。术后12 h影像检查显示术区无出血外漏,支架保持原位稳定,无扭曲、松脱及移位。术后12 h手术探查绵羊颈动脉覆膜支架区域,无出血及支架移位。术后未见绵羊四肢运动障碍、进食和行为异常。随访6个月后,造影结果显示,1例支架内血栓形成,其余8例未见血栓形成。所有绵羊在随访过程中均成活,无偏瘫及血管破溃等严重并发症。
结论 覆膜支架联合手术治疗是头颈部癌侵犯颈动脉的有效治疗方法之一。

关键词: 头颈部肿瘤, 覆膜支架, 绵羊模型

Abstract: Objective To investigate the feasibility of prepositioning covered stent in the carotid artery model of sheep and surgically removing the invaded carotid artery at the place where the invaded carotid artery was presumed to be.
Methods The carotid artery of 10 healthy sheep was selected, and the stent was placed in the place where the carotid artery was supposed to be invaded through the common iliac artery. The carotid artery area covered by the stent was cut open, and part of the artery wall covered by the stent was removed. The bleeding and loosening of the stent were observed in the operation area. The consciousness and activity of experimental animals were recorded by observing whether there was bleeding, leakage, distortion, looseness and displacement of stent in the operation area.
Results There was no local bleeding, except for one case where the stent was twisted after implantation, the remaining 9 stent grafts were successfully released, and the technical success rate was 90%. No complications occurred during the operation. The whole arterial wall covered by the stent graft was successfully removed during the operation, and the stent was well fixed during the operation. After the operation, the vital signs of the sheep were stable, without hemiplegia and limb movement disorders, and there was no bleeding or swelling in the covered stent area. The imaging equipment showed no bleeding and leakage in the operation area, and the stent remained stable in place, without distortion, loosening and displacement. At 12 hours after surgery, the area of the sheep's carotid artery stent graft was explored without bleeding or stent displacement. No postoperative dyskinesia, eating and behavioral abnormalities were observed in the sheep. The imaging equipment showed that the stent was placed stably, without loosening, twisting and displacement, and blood circulation was smooth. After 6 months of follow-up, the results of angiography showed that one case had thrombosis in the stent and the remaining 8 cases had no thrombosis. All sheep survived during follow-up without serious complications such as hemiplegia and vascular rupture.
Conclusion The combination of covered stents and surgical treatment is one of the effective methods for head and neck cancer invading carotid artery.

Key words: Head and Neck Neoplasms; Stent graft, Sheep model