鼻咽癌放疗后大出血的急诊栓塞治疗

Urgent embolization for the treatment of serious epistaxis in nasopharyngeal carcinoma after radiotherapy

目的探讨经导管动脉急症栓塞治疗鼻咽癌放疗后口鼻腔大出血的临床疗效及安全性。方法15例鼻咽癌放疗后口鼻腔大出血患者,经后鼻腔填塞、药物治疗等措施无效,在出血1～4h后行颈内、颈外动脉造影,根据造影结果,选用明胶海绵、不锈钢圈栓塞出血责任动脉。结果15例患者均在1.5h内完成栓塞治疗,成功率100%(15/15),栓塞后出血停止,有效率100%(15/15)。术后发生轻度面瘫2例,患侧面部疼痛1例,均在术后1周左右自行缓解、消失,无严重的栓塞后并发症发生。结论经导管动脉急症栓塞是救治鼻咽癌放疗后口鼻腔大出血的一种有效、安全、简便的方法。

Objective To discuss the clinical effect and safety of urgent embolization with arterial catheterization in the treatment of serious epistaxis in patients with nasopharyngeal carcinoma after radiotherapy. Methods Fifteen patients with nasopharyngeal carcinoma occurred serious epistaxis after radiotherapy. Because of failure to respond to the treatment of nasal packing and medication, embolization of the bleeding arteries with gelfoam or steel coils was carried out within 1 ～ 4 hours after the bleeding. The target arteries were judged by the internal and external carotid angiographic findings. Results The embolization procedure was successfully completed, in all of 15 patients within 1.5 hours with the technical successful rate of 100%. The bleeding ceased in all 15 patients with the effective rate of 100%. Mild facial palsy occurred in 2 cases, and facial pain of the affected side in one case. All above symptoms were relived and disappeared in about one week after the procedure, leaving no serious complications. Conclusion Urgent arterial embolization is an effective, safe and simple method for controlling the serious epistaxis in nasopharyngeal carcinoma after radiotherapy.