支架-人造血管复合体移植物在累及颈动脉的晚期头颈恶性肿瘤及其并发症治疗中的应用进展  

Application of endovascular stent graft in treatment of advanced head and neck malignancies involving carotid arteries and their complications

作　　者：张海东[1,2] 于振坤 Zhang Haidong;Yu Zhenkun(Clinical Medicine Department,School of Medicine,Southeast University,Nanjing 210096,China;Department of Otorhinolaryngology and Head and Neck Surgery,the Affiliated BenQ Hospital of Nanjing Medical University,Nanjing 210096,China)

机构地区：[1]东南大学医学院临床医学系,南京210096 [2]南京医科大学附属南京明基医院耳鼻咽喉头颈外科,南京210019

出　　处：《中华解剖与临床杂志》2023年第8期562-566,共5页Chinese Journal of Anatomy and Clinics

基　　金：南京市卫生科技发展专项资金(YKK22249)。

摘　　要：目的总结支架-人造血管复合体移植物(ESG)在累及颈动脉的晚期头颈恶性肿瘤及其并发症治疗中的应用进展。方法在美国国家生物技术信息中心、Web of Science、中国知网、万方数据等数据库中,检索2000年1月—2023年1月关于ESG在累及颈动脉的晚期头颈恶性肿瘤及其并发症手术治疗中应用的相关文献共计765篇,排除内容不符、重复研究、无法获取全文、研究质量不高及综述类文献,最终纳入40篇进行总结分析。结果对于累及颈动脉的晚期头颈恶性肿瘤,ESG联合手术切除可以在不影响颈动脉血流的情况下切除肿瘤,可最大限度地降低术中、术后发生神经后遗症的潜在风险。在晚期头颈恶性肿瘤并发症的治疗中,ESG是治疗颈动脉爆裂综合征的一种安全有效的方法,可降低血管内或外科颈动脉牺牲相关的缺血性并发症的风险,但潜在的延迟性缺血性或感染性并发症仍不容忽视。对于头颈恶性肿瘤放疗后继发颈动脉狭窄(RICS)的患者,使用ESG治疗能有效改善RICS,降低缺血性心脑血管事件的发生率,短期效果肯定,但在动脉再狭窄及缺血性心脑血管事件方面还需进一步观察。ESG内血栓形成、动脉瘤形成是置入ESG常见的并发症,其预防措施需进一步探索。结论ESG动脉内置入是累及颈动脉的头颈恶性肿瘤手术治疗及其并发症挽救性治疗的一种比较可靠的选择。Objective This study aimed to summarize the application of endovascular stent graft(ESG)in salvage treatment of advanced head and neck malignancies involving carotid artery and their complications.Methods Literature on the role of ESG in treating advanced head and neck malignancies involving carotid arteries and their complications was searched in NCBI,Web of Science,CNKI,and Wanfang databases from January 2000 to January 2023.A total of 765 literature were included,excluding irrelevant literature,duplicate literature,unable-to-obtain-full-text literature,review literature,and literature with poor research quality.Finally,40 relevant literature was included for analysis.Results For advanced head and neck malignancies involving the carotid artery,ESG combined with surgical resection can remove the tumor without affecting the carotid blood flow,thus minimizing the potential risk of intraoperative and postoperative neurological sequelae.In the treatment of complications of advanced head and neck malignancies,ESG is a safe and effective approach for treating carotid burst syndrome.It reduces the risk of ischemic complications associated with intravascular or surgical carotid artery sacrifice,but the potential for delayed ischemic or infectious complications should not be ignored.For radiation-induced carotid stenosis(RICS)after radiotherapy for head and neck malignancies,ESG treatment can effectively improve RICS and reduce the incidence of ischemic cardiovascular and cerebrovascular events,with positive short-term effects.However,further observation is needed in terms of arterial restenosis and ischemic cardiovascular and cerebrovascular events.Thrombosis and aneurysm formation in ESG are common complications of ESG implantation,and the preventive measures need to be further explored.Conclusion ESG intraarterial placement is a reliable option for surgical treatment of head and neck malignancies involving carotid artery and salvage treatment of their complications.

关 键 词：头颈部肿瘤 并发症 外科治疗 颈动脉狭窄 颈动脉爆裂综合征 支架-人造血管复合体移植物 

分 类 号：R739.91[医药卫生—肿瘤]