血管内治疗鼻咽癌放疗后颈内动脉假性动脉瘤破裂出血  

Endovascular treatment of ruptured internal carotid pseudoaneurysm with bleeding after radiotherapy for nasopharyngeal carcinoma

作　　者：申权[1] 郑曲彬[1] 谢杭[1] 池桢[1] 黄宁[1] SHEN Quan;ZHENG Qubin;XIE Hang;CHI Zhen;HUANG Ning(Department of Interventional Radiology,Affiliated Union Hospital,Fujian Medical University,Fuzhou,Fujian Province 350001,China)

机构地区：[1]福建医科大学附属协和医院介入科,福建福州350001

出　　处：《介入放射学杂志》2024年第3期304-308,共5页Journal of Interventional Radiology

摘　　要：目的探讨鼻咽癌放疗后颈内动脉假性动脉瘤破裂出血的血管内治疗方式、疗效及安全性。方法 回顾性分析福建医科大学附属协和医院收治的21例鼻咽癌放疗后颈内动脉假性动脉瘤破裂出血患者的临床资料,其中8例行覆膜支架植入,6例行支架辅助弹簧圈栓塞,7例直接行载瘤动脉闭塞治疗。分析手术策略、治疗结果以及临床与影像学随访结果。结果 21例患者均成功接受血管内治疗。术后即刻止血效果均良好,瘤颈残留2例,瘤体残留1例。术后出血复发5例,其中4例再次行载瘤动脉闭塞后出血停止,1例为覆膜支架植入后发生内漏,予球囊扩张后血止,但1个月后不明原因死亡;1例覆膜支架植入术后出现昏迷,CT示蛛网膜下腔出血、脑肿胀,治疗后未好转自动出院;3例在随访中发现颈内动脉闭塞;2例术后未随访。随访的19例患者中mRS评分0分9例,1分6例,2分2例,5分1例,6分1例。结论 针对鼻咽癌放疗后颈内动脉假性动脉瘤破裂出血,血管内治疗效果确切,安全性较高。覆膜支架短期疗效好,但也存在着动脉瘤复发、内漏等问题,载瘤动脉闭塞可能远期疗效更可靠。Objective To discuss the methods, efficacy, and safety of endovascular treatment for ruptured pseudoaneurysm hemorrhage of internal carotid artery(ICA) after radiotherapy for nasopharyngeal carcinoma(NPC). Methods The clinical data of 21 patients with ruptured pseudoaneurysm hemorrhage of ICA after radiotherapy for NPC, who were admitted to the Affiliated Union Hospital, Fujian Medical University of China, were retrospectively analyzed. The patient's surgical strategies were analyzed, the therapeutic results and the clinical and imaging follow-up results were summarized. Of the 21 patients, covered stent implantation was carried out in 8, stent-assisted coil embolization was employed in 6, and direct occlusion of parent artery was adopted in 7. Results Successful endovascular treatment was accomplished in all the 21 patients. Excellent hemostatic effect was obtained immediately after surgery. Aneurysm neck residue was observed in 2 patients,and aneurysm body residue was seen in one patients. Postoperative bleeding recurred in 5 patients, in 4 of them the bleeding stopped after once more occlusion of the parent artery, and one patient developed internal leakage after covered stent implantation and the bleeding stopped after balloon dilation, and this patient died of unknown cause one month later. One patient developed coma after covered stent implantation, CT scan demonstrated subarachnoid hemorrhage and brain swelling, and this patient showed no improvement after treatment and was self-discharged from hospital. ICA occlusion was seen in 3 patients during follow-up period,and 2 patients did not receive a postoperative follow-up visit. In the 19 patients who were followed up, the mRS score was 0 point(n=9), 1 point(n=6), 2 points(n=2), 5 points(n=1), and 6 points(n=1). Conclusion For the ruptured pseudoaneurysm hemorrhage of ICA after radiotherapy for NPC, endovascular treatment is highly safe with reliable efficacy. The covered stent implantation carries good short-term efficacy, but there are also problems such a

关 键 词：鼻咽癌 放疗 颈内动脉假性动脉瘤 血管内治疗 

分 类 号：R739.63[医药卫生—肿瘤]