中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
30期
2442-2446
,共5页
梁熙虹%郭鹏德%丁宁%陈光利
樑熙虹%郭鵬德%丁寧%陳光利
량희홍%곽붕덕%정저%진광리
颈内动脉%栓塞%球囊%颈内动脉海绵窦瘘
頸內動脈%栓塞%毬囊%頸內動脈海綿竇瘺
경내동맥%전새%구낭%경내동맥해면두루
Internal carotid artery%Occlusion%Balloon%Internal carotid artery cavernous sinus fistula
目的 评估颈内动脉栓塞在头颈部疾病治疗中的应用价值.方法 回顾性分析28例应用血管介入方法治疗的颈内动脉相关性疾病患者,根据全脑血管造影、球囊栓塞试验(BTO)结果,采取球囊、弹簧圈或胶等1种或多种联合方法栓塞瘘口或出血点,必要时栓塞颈内动脉.结果 28例患者,BTO阴性26例,阳性2例.22例成功永久栓塞颈内动脉,患者临床症状消失或协助完成肿瘤切除、拔出异物等,且未出现任何并发症.2例(颈静脉球瘤和鼻咽纤维血管瘤术后出血各1例)出现迟发性脑梗死,经溶栓抗凝治疗后,前者临床症状消失,后者症状有所缓解.1例颈内动脉海绵窦瘘(CCF)患者在栓塞过程中,球囊早泄并进入大脑中动脉分支远端,但未引起临床症状.1例患者死亡(鼻咽癌术后+放疗后出血),急诊栓塞一侧颈内动脉,栓塞侧大脑半球出现广泛性脑栓塞,出血减缓,但3d后死于鼻出血.结论 颈内动脉栓塞可以作为挽救患者生命的一个有效治疗方法,栓塞前应详细评估患者的耐受性和侧支循环开放情况.
目的 評估頸內動脈栓塞在頭頸部疾病治療中的應用價值.方法 迴顧性分析28例應用血管介入方法治療的頸內動脈相關性疾病患者,根據全腦血管造影、毬囊栓塞試驗(BTO)結果,採取毬囊、彈簧圈或膠等1種或多種聯閤方法栓塞瘺口或齣血點,必要時栓塞頸內動脈.結果 28例患者,BTO陰性26例,暘性2例.22例成功永久栓塞頸內動脈,患者臨床癥狀消失或協助完成腫瘤切除、拔齣異物等,且未齣現任何併髮癥.2例(頸靜脈毬瘤和鼻嚥纖維血管瘤術後齣血各1例)齣現遲髮性腦梗死,經溶栓抗凝治療後,前者臨床癥狀消失,後者癥狀有所緩解.1例頸內動脈海綿竇瘺(CCF)患者在栓塞過程中,毬囊早洩併進入大腦中動脈分支遠耑,但未引起臨床癥狀.1例患者死亡(鼻嚥癌術後+放療後齣血),急診栓塞一側頸內動脈,栓塞側大腦半毬齣現廣汎性腦栓塞,齣血減緩,但3d後死于鼻齣血.結論 頸內動脈栓塞可以作為輓救患者生命的一箇有效治療方法,栓塞前應詳細評估患者的耐受性和側支循環開放情況.
목적 평고경내동맥전새재두경부질병치료중적응용개치.방법 회고성분석28례응용혈관개입방법치료적경내동맥상관성질병환자,근거전뇌혈관조영、구낭전새시험(BTO)결과,채취구낭、탄황권혹효등1충혹다충연합방법전새루구혹출혈점,필요시전새경내동맥.결과 28례환자,BTO음성26례,양성2례.22례성공영구전새경내동맥,환자림상증상소실혹협조완성종류절제、발출이물등,차미출현임하병발증.2례(경정맥구류화비인섬유혈관류술후출혈각1례)출현지발성뇌경사,경용전항응치료후,전자림상증상소실,후자증상유소완해.1례경내동맥해면두루(CCF)환자재전새과정중,구낭조설병진입대뇌중동맥분지원단,단미인기림상증상.1례환자사망(비인암술후+방료후출혈),급진전새일측경내동맥,전새측대뇌반구출현엄범성뇌전새,출혈감완,단3d후사우비출혈.결론 경내동맥전새가이작위만구환자생명적일개유효치료방법,전새전응상세평고환자적내수성화측지순배개방정황.
Objective To evaluate the efficiency of the internal carotid artery (ICA) occlusion in treatment of head and neck diseases.Methods To retrospectively analyze 28 cases related with the ICA.According to the result of balloon test occlusion (BTO) and cerebral angiogram,the balloon,spring coil or glue were used to block the fistula or haemorrhage,sometimes even to embolism the related ICA.Results Twenty-six cases and 2 cases presented negative and positive in total 28 cases in BTO.Of the 26 patients,22 were succeed in ICA occlusion.The clinical symptoms disappeared in some patients,and the others had the related tumor or foreign body being resected.Two cases (glomus jugulare tumors and intractable epistaxis after Juvenile nasopharyngeal angiofibroma surgery in 1 case respectively) presented delayed cerebral infarction.With the thrombolysis anticoagulant therapy,the clinical symptoms in the former disappeared and in the later reduced.The balloon was let out in 1 case with the embolism the distal middle cerebral artery branches.However,the patient did not show any symptoms during the operation and observation period.One case with intractable epistaxis in nasopharygeal cancer after radiotherapy was dead.In emergency,the left ICA was blocked,then bleeding reduced with the left hemisphere presented extensive cerebral embolism.However,he died in nasal bleeding in three days.Conclusions ICA occlusion was an efficient method to save the life.Moreover,the patient's tolerance and collateral circulation should be evaluated in detail before the operation.
