鼻咽癌治疗后鼻咽大出血出血部位的判定及治疗  

Management of intractable epistaxis and bleeding points localization of post-therapy nasopharyngealcarcinoma

作　　者：何承诚[1] 司勇锋[1] 余雷[2] 陶仲强[1] 

机构地区：[1]广西壮族自治区人民医院耳鼻咽喉头颈肿瘤科,南宁530021 [2]广西壮族自治区人民医院肿瘤介入科,南宁530021

出　　处：《中华耳鼻咽喉头颈外科杂志》2012年第3期191-195,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：广西壮族自治区卫生厅自筹基金项目（Z2008036）

摘　　要：目的总结分析鼻咽癌治疗后鼻咽大出血的部位、治疗方法及疗效。方法对16例鼻咽癌治疗后发生鼻咽大出血患者的出血部位及治疗方案、疗效进行回顾性分析。本组中7例患者鼻咽大出血发生在首程治疗，9例为复发再治疗，鼻咽部放疗量为70～160Gy。16例患者均有先兆出血症状，发生大出血时间距最后一次放疗1-204个月，中位时间13个月。结果16例患者的出血部位依次为：8例颈内动脉出血，7例颈外动脉上颌动脉分支出血，1例为咽升动脉分支出血。采用颈内外动脉血管造影10例。本组所有患者开始均采用前后鼻孔堵塞，共有9例患者行气管切开术。采用血管造影术左颈内动脉球囊栓塞1例，颈外动脉上颌支栓塞6例，颈外动脉结扎术1例，前后鼻孔填塞1例。8例颈内动脉破裂出血者7例死亡，1例治愈；7例颈外动脉上颌动脉分支破裂出血和1例咽升动脉分支出血者获临床治愈，随访1-3个月无复发。结论血管造影术是判断鼻咽癌治疗后鼻咽大出血部位的主要方法，血管内栓塞治疗并结合鼻腔填塞和气管切开是治疗鼻咽大出血的主要措施。鼻咽癌治疗后颈内动脉破裂出血在目前仍是死亡率较高的疾病。Objective To investigate the bleeding points and the management of post-therapy nasopharyngeal carcinoma intracta epistaxis. Methods The bleeding points, treatment as well as its effects were studied retrospectively in 16 cases of post-therapy nasopharyngeal carcinoma intractable epistaxis. Among them 7 cases had been treated once, 9 cases recurred and received second treatment. Nasopharynx area had received radiotherapy from 70 - 160 Gy. Nasopharyngeal carcinoma intractable epistaxis occurred in 1 -204 months （ median time 13 months） after radiotherapy. Results The bleeding points were found in the following different sites： internal carotid artery 8 patients, the internal maxillary artery of external carotid artery 7 patients, the arteriae pharyngea ascendens of external carotid artery 1 patient. All patients were itially by oronasal packing or intranasal balloons, 9 cases were carried out emergency tracheotomy. Post- therapy nasopharyngeal carcinoma intractableepistaxis was well controlled by transcatheter internal carotid artery balloon embolization in 1 case, transcatheter maxillary artery embolication in 6 cases, external carotid artery hgation in 1 case. Voluntarily stopping bleeding in 1 case. Seven cases among internal carotid artery 8 patients died, 1 case recovery. Seven patients of the internal maxillary artery of external carotid artery and 1 patient of the arteriae pharyngea ascendens of external carotid artery was recovery. There were no complications during a followed-up for 1 - 3 months after treatment. Conclusions After determined the points of post-therapy nasopharyngeal carcinoma epistaxis by angiography mainly the key factors in treatment of epistaxis of post-therapy nasopharyngeal carcinoma were vigorous applicated intractable endovascular treatment, nasal packing and tracheostomy. Internal carotid artery bleeding of post-therapy nasopharyngeal carcinoma still have the high mortality rate at present.

关 键 词：鼻咽肿瘤 放射疗法 出血 血管造影术 栓塞 治疗性 气管切开术 

分 类 号：R739.63[医药卫生—肿瘤]