鼻咽癌患者放疗后颈内动脉假性动脉瘤破裂大出血介入治疗效果分析  

Interventional therapy for the rupture of internal carotid artery pseudoaneurysm with massive bleeding in patients with nasopharyngeal carcinoma after receiving radiotherapy:analysis of the clinical effect

作　　者：林志鹏 邹旭公 胡小龙 陈都 刘辉来[1] 黄大钡[1] 陈源[1] 李晓群[1] 张健[1] LIN Zhipeng;ZOU Xugong;HU Xiaolong;CHEN Du;LIU Huilai;HUANG Dabei;CHEN Yuan;LI Xiaoqun;ZHANG Jian(Department of Interventional Medicine,Zhongshan Municipal People's Hospital,Zhongshan,Guangdong Province 528499,China)

机构地区：[1]中山市人民医院介入医学科,广东中山528499

出　　处：《介入放射学杂志》2023年第9期881-886,共6页Journal of Interventional Radiology

摘　　要：目的评估鼻咽癌患者放射治疗后颈内动脉假性动脉瘤破裂大出血接受介入治疗的安全性、有效性及并发症发生情况。方法纳入2016年1月至2020年12月在中山市人民医院因鼻咽癌放疗后颈内动脉假性动脉瘤破裂大出血接受介入治疗的患者,分析患者术后止血率、术后1年再出血率、并发症发生率、术后1年生存率。结果共纳入23例患者,其中8例患者接受动脉覆膜支架植入治疗,15例患者接受颈内动脉弹簧圈闭塞治疗。手术成功率100%,术后1年再出血率4.3%(1/23),为覆膜支架植入术患者;并发症发生率为17.4%(4/23),4例均为弹簧圈闭塞治疗患者,其中2例患者术后出现大面积脑梗死,2例术后出现不同程度神经系统症状;术后1年生存率为91.3%。结论鼻咽癌放疗后颈内动脉假性动脉瘤破裂大出血罕见,但危险性高,介入治疗能有效止血及闭塞假性动脉瘤,且复发率低,能有效降低患者病死率。Objective To evaluate the safety,efficacy and complications of interventional therapy for the rupture of internal carotid artery pseudoaneurysm with massive bleeding in patients with nasopharyngeal carcinoma after receiving radiotherapy.Methods Patients with nasopharyngeal carcinoma,who received interventional therapy due to the rupture of internal carotid artery pseudoaneurysm with massive bleeding after radiotherapy at the Zhongshan People's Hospital of China between January 2016 and December 2020,were enrolled in this study.The postoperative hemostasis rate,postoperative one-year rebleeding rate,incidence of complications,and postoperative one-year survival rate were analyzed.Results A total of 23 patients were enrolled in this study.Of the 23 patients,covered stent implantation treatment was employed in 8,and spring coil occlusion treatment of internal carotid artery in 15.The operation success rate was 100%.The postoperative one-year rebleeding rate was 4.3%(1/23),the rebleeding occurred in one patient receiving covered stent implantation treatment.The incidence of complications was 17.4%(4/23),all the complications occurred in 4 patients receiving spring coil occlusion treatment,including large-area cerebral infarction(n=2)and different degrees of neurological symptoms(n=2).The postoperative one-year survival rate was 91.3%.Conclusion Clinically,the rupture of internal carotid artery pseudoaneurysm with massive bleeding in patients with nasopharyngeal carcinoma after receiving radiotherapy is very rare,but it is a life-threatening condition.Interventional therapy is very effective in achieving hemostasis and obstructing the pseudoaneurysm,the recurrence rate of bleeding is lower,and it can effectively reduce the mortality of patients.

关 键 词：鼻咽癌 放射治疗 颈内动脉假性动脉瘤 覆膜支架 

分 类 号：R739.63[医药卫生—肿瘤]