CAJ | 학술논문

目的总结头颈肿瘤治疗中发生颈动脉破裂大出血的原因、抢救方法及抢救效果.方法回顾性分析1980-2008年间中国医学科学院肿瘤医院头颈外科治疗的30例发生颈动脉破裂大出血的头颈肿瘤患者资料,其中男24例,女6例;年龄32～76岁,中位年龄53岁.其中下咽癌11例,喉癌5例,甲状腺癌6例,其他恶性肿瘤8例.24例患者术前行放射治疗,剂量为40～126 Gy,其中40～50 Gy 6例,60～70 Gy 12例,90 Gy以上6例.10例患者入院前曾行至少1次手术治疗.本组患者经外科手术治疗后发生颈动脉破裂出血,出血时间为术后5～47 d,平均20.1 d.出血原因为咽或食管瘘、伤口裂开、伤口感染及组织瓣坏死.有先兆出血的患者14例.结果出血后及时压迫止血,保持气道通畅,颈动脉结扎前清醒25例,昏迷2例,因出血死亡3例.急诊行单纯颈动脉结扎7例,颈动脉结扎加胸大肌皮瓣修复17例,颈动脉加无名动脉结扎3例.术后意识、生命体征及四肢活动均正常者22例;1例无名动脉结扎者术后昏迷,生命体征平稳,21 d后因经济原因自动出院无随访;1例术后因脑梗死昏迷偏瘫,经治疗后好转;另有1例患者出现短暂性肌力下降.2例结扎前昏迷患者昏迷2 d后死亡.随访3～132个月,中位随访时间16个月,6例生存5年以上.结论颈动脉破裂大出血是晚期头颈肿瘤多次放疗和(或)术后严重的并发症之一,及时动脉压迫止血及保持气道通畅是能否抢救成功的关键.只要颈动脉结扎前能保证患者清醒,一般情况下术后死亡或偏瘫的可能性较小.
목적 총결두경종류치료중발생경동맥파렬대출혈적원인、창구방법 급창구효과.방법 회고성분석1980-2008년간중국의학과학원종류의원두경외과치료적30례발생경동맥파렬대출혈적두경종류환자자료,기중남24례,녀6례;년령32～76세,중위년령53세.기중하인암11례,후암5례,갑상선암6례,기타악성종류8례.24례환자술전행방사치료,제량위40～126 Gy,기중40～50 Gy 6례,60～70 Gy 12례,90 Gy이상6례.10례환자입원전증행지소1차수술치료.본조환자경외과수술치료후발생경동맥파렬출혈,출혈시간위술후5～47 d,평균20.1 d.출혈원인위인혹식관루、상구렬개、상구감염급조직판배사.유선조출혈적환자14례.결과 출혈후급시압박지혈,보지기도통창,경동맥결찰전청성25례,혼미2례,인출혈사망3례.급진행단순경동맥결찰7례,경동맥결찰가흉대기피판수복17례,경동맥가무명동맥결찰3례.술후의식、생명체정급사지활동균정상자22례;1례무명동맥결찰자술후혼미,생명체정평은,21 d후인경제원인자동출원무수방;1례술후인뇌경사혼미편탄,경치료후호전;령유1례환자출현단잠성기력하강.2례결찰전혼미환자혼미2 d후사망.수방3～132개월,중위수방시간16개월,6례생존5년이상.결론 경동맥파렬대출혈시만기두경종류다차방료화(혹)술후엄중적병발증지일,급시동맥압박지혈급보지기도통창시능부창구성공적관건.지요경동맥결찰전능보증환자청성,일반정황하술후사망혹편탄적가능성교소.
Objective To assess the efficacy and safety of carotid ligation in the treatment of the carotid artery rupture(CAR). Methods A series of 30 patients who had CAR treated with carotid ligation were reviewed. There were 24 males and 6 females ranging in age from 32 to 76 years, with a mean of 53.9 years. The original sites of tumours were hypopharynx(n=11), larynx(n=5), thyroid (n= 6) and others(n =8). Of the 30 patients, 24 patients had received radiotherapy from 40 - 126 Gy and 10 patients underwent one or more surgical treatments. CAR in all cases occurred after surgical operation. CAR occurred in 5 -21 days after operation. Results By pressing the carotid and keeping breathe of the patients immediately after CAR, 25 patients were conscious, 2 patients in coma, and 3 patients died before carotid ligation. Seven cases were applied with carotid ligation, 3 cases with the combined ligation of carotid and brachiophatic arteries, and 17 cases with carotid ligation plus the repair by pectoralis major myocutaneous flap. The causes of CAR concluded fistula, wound dehiscence, wound infection and transferred flap necrosis. The omende hemorrhage occurred in 14 patients. Of 25 cases with the treatments of carotid ligation, 22 patients survived with no complication, 1 with brief muscle weakness and 2 with unconscious.Clinical follow-up period lasted more than 5 years at least in 6 patients. Conclusions CAR is the most dangerous complication in advanced carcinoma of the head and neck. The prompt hemostasis and carotid ligation are effective methods to rescue patients of CAR. It is important to keep patients conscious before carotid ligation surgery, with low rates of death and hemiplegia postoperatively.