頸動脈血行再建後に頸部郭清術を行った喉頭癌症例

Abstract

In the surgical treatment of head and neck cancer, when tumors invade the carotid artery, there is a fear of cerebral ischemic complications during resection of these lesions with the involved carotid artery. Vascular reconstruction is useful in cases of radical neck dissection with the carotid artery resection. Numata et al. (1992) developed a surgical procedure for treating these cases, namely, the contralateral external carotid-middle cerebral artery bypass operation. We presented a case treated using this technique. The case was a 66 year-old male who underwent a total laryngectomy one year ago. He subsequently noted a painless right cervical node, and CT scanning revealed neck metastases involving the right internal carotid artery. Preoperative tests were performed to evaluate the carotid arterial system, including an evaluation of arterial stump pressure and temporary balloon occlusion of the right internal carotid artery. He underwent surgery using Numata's procedure, involving a left external carotid-right middle cerebral artery bypass with autologous great saphenous vein grafting. After three weeks, right neck dissection with the carotid artery resection was performed. He had no cerebral ischemic complications and has had no recurrence for 13 months.