颈内动脉栓塞在头颈部相关疾病治疗中的临床应用  

Clinical application of internal carotid artery occlusion

作　　者：梁熙虹[1] 郭鹏德[3] 丁宁[2] 陈光利[1] 

机构地区：[1]首都医科大学附属北京同仁医院放射科,100730 [2]首都医科大学附属北京同仁医院急诊科,100730 [3]北京中医药大学东方医院放射科

出　　处：《中华医学杂志》2015年第30期2442-2446,共5页National Medical Journal of China

摘　　要：目的 评估颈内动脉栓塞在头颈部疾病治疗中的应用价值.方法 回顾性分析28例应用血管介入方法治疗的颈内动脉相关性疾病患者,根据全脑血管造影、球囊栓塞试验（BTO）结果,采取球囊、弹簧圈或胶等1种或多种联合方法栓塞瘘口或出血点,必要时栓塞颈内动脉.结果 28例患者,BTO阴性26例,阳性2例.22例成功永久栓塞颈内动脉,患者临床症状消失或协助完成肿瘤切除、拔出异物等,且未出现任何并发症.2例（颈静脉球瘤和鼻咽纤维血管瘤术后出血各1例）出现迟发性脑梗死,经溶栓抗凝治疗后,前者临床症状消失,后者症状有所缓解.1例颈内动脉海绵窦瘘（CCF）患者在栓塞过程中,球囊早泄并进入大脑中动脉分支远端,但未引起临床症状.1例患者死亡（鼻咽癌术后＋放疗后出血）,急诊栓塞一侧颈内动脉,栓塞侧大脑半球出现广泛性脑栓塞,出血减缓,但3d后死于鼻出血.结论 颈内动脉栓塞可以作为挽救患者生命的一个有效治疗方法,栓塞前应详细评估患者的耐受性和侧支循环开放情况.Objective To evaluate the efficiency of the internal carotid artery （ICA） occlusion in treatment of head and neck diseases.Methods To retrospectively analyze 28 cases related with the ICA.According to the result of balloon test occlusion （BTO） and cerebral angiogram,the balloon,spring coil or glue were used to block the fistula or haemorrhage,sometimes even to embolism the related ICA.Results Twenty-six cases and 2 cases presented negative and positive in total 28 cases in BTO.Of the 26 patients,22 were succeed in ICA occlusion.The clinical symptoms disappeared in some patients,and the others had the related tumor or foreign body being resected.Two cases （glomus jugulare tumors and intractable epistaxis after Juvenile nasopharyngeal angiofibroma surgery in 1 case respectively） presented delayed cerebral infarction.With the thrombolysis anticoagulant therapy,the clinical symptoms in the former disappeared and in the later reduced.The balloon was let out in 1 case with the embolism the distal middle cerebral artery branches.However,the patient did not show any symptoms during the operation and observation period.One case with intractable epistaxis in nasopharygeal cancer after radiotherapy was dead.In emergency,the left ICA was blocked,then bleeding reduced with the left hemisphere presented extensive cerebral embolism.However,he died in nasal bleeding in three days.Conclusions ICA occlusion was an efficient method to save the life.Moreover,the patient＆#39;s tolerance and collateral circulation should be evaluated in detail before the operation.

关 键 词：颈内动脉 栓塞 球囊 颈内动脉海绵窦瘘 

分 类 号：R543.4[医药卫生—心血管疾病]