CAJ | 학술논문

目的：分析鼻咽癌放疗后大出血的相关危险因素，探讨鼻咽癌放疗后出血的临床预防及诊治措施。方法：回顾分析中山大学孙逸仙纪念医院2007年1月至2012年6月诊治的鼻咽癌放疗后出现大出血患者30例的临床特点、治疗方式并结合文献进行总结。结果：25例患者行膨胀海绵填塞止血，3例患者在鼻内镜下行射频烧灼止血，5例患者行动脉插管血管造影选择性动脉栓塞术（DSA）止血。22例抢救成功，死亡8例（死亡率26.6%）。单程放疗发生大出血的潜伏期为3～12年，出血量为200～1200 mL；再程放疗潜伏期为6个月至3年，出血量为300～8000 mL。结论：后鼻腔填塞止血、鼻内镜下烧灼止血及选择性动脉栓塞是目前可行有效的止血措施，发生大出血的潜伏期及出血量与患者的年龄、肿瘤分期和是否为再程放疗有关；其中高龄、肿瘤分期晚和再程放疗的患者出血潜伏期短，出血量大。
목적：분석비인암방료후대출혈적상관위험인소，탐토비인암방료후출혈적림상예방급진치조시。방법：회고분석중산대학손일선기념의원2007년1월지2012년6월진치적비인암방료후출현대출혈환자30례적림상특점、치료방식병결합문헌진행총결。결과：25례환자행팽창해면전새지혈，3례환자재비내경하행사빈소작지혈，5례환자행동맥삽관혈관조영선택성동맥전새술（DSA）지혈。22례창구성공，사망8례（사망솔26.6%）。단정방료발생대출혈적잠복기위3～12년，출혈량위200～1200 mL；재정방료잠복기위6개월지3년，출혈량위300～8000 mL。결론：후비강전새지혈、비내경하소작지혈급선택성동맥전새시목전가행유효적지혈조시，발생대출혈적잠복기급출혈량여환자적년령、종류분기화시부위재정방료유관；기중고령、종류분기만화재정방료적환자출혈잠복기단，출혈량대。
Objective:To explore the clinical measurements for preventing and curing epistaxis in patients irradiated for nasopharyngeal carcinoma by analyzing the related factors. Methods:Thirty patients irradiated for nasopharyngeal carcinoma and consequently presented epistaxis were retrospectively reviewed by analyzing the clinical characteristics and measurements. Literature review was also performed. Results:Twenty-two cases were successfully rescued, and eight cases died (mortality rate:26.6%). Twenty-five cases underwent inflation sponge packing hemostasis, whereas three cases underwent endoscopic hemostasis with cauterization. Five patients underwent digital subtraction angiography (DSA) and selective arterial embolization. For patients who underwent one irradiation course, the epistaxis latent period ranged from 3 to 12 years, and the amount of bleeding ranged from 200 mL to 1 200 mL. For patients who underwent more than one irradiation course, the epistaxis latent period ranged from 6 months to 3 years, and the amount of bleeding ranged from 300 mL to 8 000 mL. Conclusion:Packing through choanal atresia by using inflation sponge, cautery under endoscopy, DSA, and selective arterial embolization are useful and effective measurements for hemostasis. The epistaxis latent period and volume are related to the age, tumor stage, and ir-radiation course of the patients. Patients with advanced age, tumor stage, and more than one irradiation course have short latent period and high amount of bleeding.