Objective: To investigate the safety and timing selection of using shunt tube during surgery for complicated carotid body tumor (CBT).
Methods: The clinical data of 85 patients with Shamblin II or III CBT undergoing surgical resection in the Department of Vascular Surgery, Peking University People’s Hospital between January 2002 and March 2018 were retrospectively analyzed. Of the patients, the carotid shunt tube was used in 33 cases (shunt tube group), and was not used in the other 52 cases (non-shunt tube group). The main clinical variables of the two groups of patients were analyzed and compared.
Results: The proportion of cases with ShamblinIII tumor was significantly higher in shunt tube group than that in non-shunt tube group (P<0.05), but no significant differences were noted in other preoperative data between the two groups (P>0.05). In shunt tube group, all the 33 cases underwent internal carotid artery reconstruction, 9 cases had repair with a great saphenous vein patch, and 24 cases underwent reconstruction by end-to-end anastomosis due to severe rupture. Of the 52 patients in non-shunt tube group, 2 cases underwent internal carotid artery reconstruction and simultaneous external carotid artery ligation, 14 cases underwent simple external carotid artery ligation, and 6 cases underwent external carotid artery reconstruction. The operative time, intraoperative blood loss and incidence of short-term neurological complications were significantly increased in shunt tube group compared with non-shunt tube group (all P<0.05), while no statistical differences were found in incidence of postoperative arterial stenosis and long-term neurological injury between the two groups (both P>0.05).
Conclusion: Using a carotid shunt tube in surgery for complex Shamblin II orIII CBT is a safe and effective procedure, with no risk of increasing cerebrovascular complications and vascular shunt application, nor influence on long-term nerve injury. Once carotid artery is ruptured, shunt tube should be used immediately in order to maintain the cerebral circulation, which may be helpful for reducing bleeding and operative time, as well as the occurrence of irreversible nerve injury.