頸動脈置換を施行した頭頸部癌の2症例

Two Cases of Reconstruction of the Carotid Artery in Head and Neck Carcinomas

　はじめに

　頭頸部癌の頸部転移の手術として頸部郭清術が用いられている。この場合頸部大血管とくに頸動脈への浸潤例では従来手術の適応とならないことが多かった。しかし最近の医療技術の進歩，医療機器の改良により症例によっては頸動脈そのものも摘出する拡大した頸部郭清術が考慮されている。今回われわれは，頸動脈への浸潤が疑われた頭頸部癌2症例に対し，頸動脈置換術を施行したので報告する。

It is necessary to resect a part of the carotid artery when metastatic lymph nodes of head and neck carcinomas invade the wall of the carotid artery. However, the high rates of com-plications and death caused by cerebral vascular insufficiency after the carotid artery resection have been reported. In this paper, two patients with head and neck cancer treated with carotid artery resection and vascular replacement were reported. The indication of the reconstruction of the carotid artery should be determined preope-ratively. CT and MRI have some advantages in investigating the relationship between the tumor and the carotid artery and the other soft tissues in the neck. By using of radiogra-phy, echography, Gallium and bone scintigram, and thoraco-abdominal CT, it is indispensable to detect distant metastasis. Angiography is useful to assess the crossover flow from the con-tralateral carotid. Furthermore, the Matas test with monitoring electroencephalogram is reliable to determine the patient's tolerance for carotid ligation.