中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2012年
3期
191-195
,共5页
何承诚%司勇锋%余雷%陶仲强
何承誠%司勇鋒%餘雷%陶仲彊
하승성%사용봉%여뢰%도중강
鼻咽肿瘤%放射疗法%出血%血管造影术%栓塞,治疗性%气管切开术
鼻嚥腫瘤%放射療法%齣血%血管造影術%栓塞,治療性%氣管切開術
비인종류%방사요법%출혈%혈관조영술%전새,치료성%기관절개술
Nasopharyngeal neoplasms%Radiotherapy%Hemorrhage%AngiographyEmbolization,therapeutic%Tracheotomy
目的 总结分析鼻咽癌治疗后鼻咽大出血的部位、治疗方法及疗效.方法 对16例鼻咽癌治疗后发生鼻咽大出血患者的出血部位及治疗方案、疗效进行回顾性分析.本组中7例患者鼻咽大出血发生在首程治疗,9例为复发再治疗,鼻咽部放疗量为70 ～ 160 Gy.16例患者均有先兆出血症状,发生大出血时间距最后一次放疗1～204个月,中位时间13个月.结果 16例患者的出血部位依次为:8例颈内动脉出血,7例颈外动脉上颌动脉分支出血,1例为咽升动脉分支出血.采用颈内外动脉血管造影10例.本组所有患者开始均采用前后鼻孔堵塞,共有9例患者行气管切开术.采用血管造影术左颈内动脉球囊栓塞1例,颈外动脉上颌支栓塞6例,颈外动脉结扎术1例,前后鼻孔填塞1例.8例颈内动脉破裂出血者7例死亡,1例治愈；7例颈外动脉上颌动脉分支破裂出血和1例咽升动脉分支出血者获临床治愈,随访1～3个月无复发.结论 血管造影术是判断鼻咽癌治疗后鼻咽大出血部位的主要方法,血管内栓塞治疗并结合鼻腔填塞和气管切开是治疗鼻咽大出血的主要措施.鼻咽癌治疗后颈内动脉破裂出血在目前仍是死亡率较高的疾病.
目的 總結分析鼻嚥癌治療後鼻嚥大齣血的部位、治療方法及療效.方法 對16例鼻嚥癌治療後髮生鼻嚥大齣血患者的齣血部位及治療方案、療效進行迴顧性分析.本組中7例患者鼻嚥大齣血髮生在首程治療,9例為複髮再治療,鼻嚥部放療量為70 ～ 160 Gy.16例患者均有先兆齣血癥狀,髮生大齣血時間距最後一次放療1～204箇月,中位時間13箇月.結果 16例患者的齣血部位依次為:8例頸內動脈齣血,7例頸外動脈上頜動脈分支齣血,1例為嚥升動脈分支齣血.採用頸內外動脈血管造影10例.本組所有患者開始均採用前後鼻孔堵塞,共有9例患者行氣管切開術.採用血管造影術左頸內動脈毬囊栓塞1例,頸外動脈上頜支栓塞6例,頸外動脈結扎術1例,前後鼻孔填塞1例.8例頸內動脈破裂齣血者7例死亡,1例治愈；7例頸外動脈上頜動脈分支破裂齣血和1例嚥升動脈分支齣血者穫臨床治愈,隨訪1～3箇月無複髮.結論 血管造影術是判斷鼻嚥癌治療後鼻嚥大齣血部位的主要方法,血管內栓塞治療併結閤鼻腔填塞和氣管切開是治療鼻嚥大齣血的主要措施.鼻嚥癌治療後頸內動脈破裂齣血在目前仍是死亡率較高的疾病.
목적 총결분석비인암치료후비인대출혈적부위、치료방법급료효.방법 대16례비인암치료후발생비인대출혈환자적출혈부위급치료방안、료효진행회고성분석.본조중7례환자비인대출혈발생재수정치료,9례위복발재치료,비인부방료량위70 ～ 160 Gy.16례환자균유선조출혈증상,발생대출혈시간거최후일차방료1～204개월,중위시간13개월.결과 16례환자적출혈부위의차위:8례경내동맥출혈,7례경외동맥상합동맥분지출혈,1례위인승동맥분지출혈.채용경내외동맥혈관조영10례.본조소유환자개시균채용전후비공도새,공유9례환자행기관절개술.채용혈관조영술좌경내동맥구낭전새1례,경외동맥상합지전새6례,경외동맥결찰술1례,전후비공전새1례.8례경내동맥파렬출혈자7례사망,1례치유；7례경외동맥상합동맥분지파렬출혈화1례인승동맥분지출혈자획림상치유,수방1～3개월무복발.결론 혈관조영술시판단비인암치료후비인대출혈부위적주요방법,혈관내전새치료병결합비강전새화기관절개시치료비인대출혈적주요조시.비인암치료후경내동맥파렬출혈재목전잉시사망솔교고적질병.
Objective To investigate the bleeding points and the management of post-therapy nasopharyngeal carcinoma intracta epistaxis.Methods The bleeding points,treatment as well as its effects were studied retrospectively in 16 cases of post-therapy nasopharyngeal carcinoma intractable epistaxis.Among them 7 cases had been treated once,9 cases recurred and received second treatment. Nasopharynx area had received radiotherapy from 70 - 160 Gy.Nasopharyngeal carcinoma intractable epistaxis occurred in 1 - 204 months ( median time 13 months) after radiotherapy.Results The bleeding points were found in the following different sites:internal carotid artery 8 patients,the internal maxillary artery of external carotid artery 7 patients,the arteriae pharyngea ascendens of external carotid artery 1 patient. All patients were itially by oronasal packing or intranasal balloons,9 cases were carried out emergency tracheotomy. Posttherapy nasopharyngeal carcinoma intractableepistaxis was well controlled by transcatheter internal carotid artery balloon embolization in 1 case,transcatheter maxillary artery embolication in 6 cases,external carotid artery ligation in 1 case.Voluntarily stopping bleeding in 1 case.Seven cases among internal carotid artery 8 patients died,1 case recovery.Seven patients of the internal maxillary artery of external carotid artery and 1 patient of the arteriae pharyngea ascendens of external carotid artery was recovery. There were no complications during a followed-up for 1 - 3 months after treatment.Conclusions After determined the points of post-therapy nasopharyngeal carcinoma epistaxis by angiography mainly the key factors in treatment of epistaxis of post-therapy nasopharyngeal carcinoma were vigorous applicated intractable endovascular treatment,nasal packing and tracheostomy. Internal carotid artery bleeding of post-therapy nasopharyngeal carcinoma still have the high mortality rate at present.
