鼻咽癌放疗后颈内动脉爆裂综合征的治疗策略  

Treatment strategy of carotid blowout syndrome after radiotherapy for nasopharyngeal carcinoma

作　　者：李海艳[1] 施展[1] 张强[1] 佟小光[2] 尚彦国[2] 王轩[2] 高恺明[2] 冯国栋 刘钢[1] 翟翔[1] LI Haiyan;SHI Zhan;ZHANG Qiang;TONG Xiaoguang;SHANG Yanguo;WANG Xuan;GAO Kaiming;FENG Guodong;LIU Gang;ZHAI Xiang(Department of Otolaryngology,Tianjin Huanhu Hospital,Tianjin,300350,China;Department of Neurosurgery,Tianjin Huanhu Hospital;Department of Otolaryngology,Peking Union Medical College Hospital)

机构地区：[1]天津市环湖医院耳鼻咽喉头颈外科,天津300350 [2]天津市环湖医院复合脑血管外科 [3]北京协和医院耳鼻咽喉头颈外科

出　　处：《临床耳鼻咽喉头颈外科杂志》2024年第6期467-471,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的探讨鼻咽癌放疗后颈内动脉破裂的治疗策略。方法回顾性分析2020年3月—2023年3月收治的7例鼻咽癌放疗后颈内动脉破裂出血患者的临床资料。结果7例患者中4例发生颅底骨坏死伴感染,3例肿瘤复发伴感染。DSA造影提示6例颈内动脉破裂位于颈内动脉岩骨段,1例位于斜坡旁段。6例患者行球囊闭塞试验(BOT),通过3例,未通过3例。血管治疗方案:颈内动脉长程栓塞4例,假性动脉瘤栓塞1例(再出血),覆膜支架1例(再出血),手术中肌肉压迫1例,再出血的患者行高流量搭桥。栓塞后脑梗死3例,经过治疗无后遗症,90 d内无死亡患者。出血控制后3例颅底坏死感染者均行手术治疗清除坏死骨质,并组织瓣修复,1例复发患者行伽马刀及靶向治疗,1例行免疫及手术治疗,1例免疫及靶向治疗。结论鼻咽癌放疗后颈内动脉爆裂与肿瘤侵犯和放疗后的损伤和局部组织感染密切相关。对于肿瘤侵犯导致的,建议牺牲责任血管;对于感染造成的破裂出血,建议保留血管,并尽早手术。紧急血管闭塞仍是挽救生命的选择。Objective To investigate the treatment of internal carotid artery rupture after radiotherapy for nasopharyngeal carcinoma.Methods The clinical data of 7 patients with internal carotid artery rupture after radiotherapy for nasopharyngeal carcinoma from March 2020 to March 2023 were retrospectively analyzed.Results Skull base osteonecrosis with infection occurred in 4 cases,and tumor recurrence with infection in 3 cases.DSA showed that internal carotid artery rupture was located in the internal carotid artery petrosal segment in 6 cases,and in the paravicular segment in 1 case.Balloon occlusion test(BOT)was performed in 6 patients,of which 3 passed and 3 failed.Vascular treatment included internal carotid artery embolization(4 cases),false aneurysm embolization 1 case(rebleeding),coated stent 1 case(rebleeding),muscle compression during operation(1 case).Patients with rebleeding received high-flow bypass.Three cases developed cerebral infarction after embolization without severe sequelae after treatment,and no death occurred within 90 days.After bleeding control,all 3 patients with cranial base necrosis received surgical treatment to remove the necrotic bone and tissue flap repair,and 1 patient with recurrence received gamma knife and targeted therapy,1 patient received immune and surgical therapy,and 1 patient received immune and targeted therapy.Conclusion Rupture and hemorrhage of internal carotid artery after radiotherapy is related to tumor invasion,tissue injury and local infection after radiotherapy.For those caused by tumor invasion,it is recommended to sacrifice the responsible vessels.For those caused by infection,emergency surgery is recommended and blood vessels preserved.Emergency vascular occlusion remains a life-saving option.

关 键 词：鼻咽肿瘤 颈内动脉爆裂综合征 血管介入治疗 

分 类 号：R739.63[医药卫生—肿瘤]