血管结扎术治疗颈部血管破裂

Initial application of carotid ligation simply for(Internal)carotid arteriorhexis in advanced head and neck cancer

目的探讨恶性肿瘤侵犯颈总动脉、颈内动脉致动脉破裂后紧急行单纯血管结扎术的应用价值及并发症分析。方法回顾分析1989年11月～2004年5月间病例共11例(发生破裂为13例次),其中喉咽癌1例,鼻咽癌1例,食管癌2例,喉癌4例(1例喉癌反复破裂3次),口颊癌1例,甲状腺癌2例；有放疗病史9例,最大剂量130Gy：合并咽瘘7例。颈总动脉破裂10人次,颈内动脉破裂3人次。全部病例均是肿瘤复发患者,为动脉破裂后行紧急结扎止血。4例颈总动脉破裂者行术中残端血管测压。术后随访3个月～3．5年。结果颈总动脉结扎10例次,颈内动脉结扎3例次：其中1例喉癌第1次颈总动脉结扎后无并发症,18天后远心残端破裂行颈内动脉结扎,术后6小时出现轻度偏瘫；其他均无偏瘫、失语、精神障碍、肢体运动障碍等并发症。4例行术中颈动脉残端测压者其残端血压与动脉压之比值均＞50%。结论①恶性肿瘤侵犯颈总动脉、颈内动脉后由于血管长期受压,脑血流代偿多已形成,单纯结扎血管并发症少,是一可行紧急处理方案；②术中残端血管测压对治疗方案的选择及预后有重要价值。

OBJECTIVE To evaluate the significance of carotid ligation simply for common （internal） carotid arteriorhexis in advanced head and neck cancer. METHODS The clinical data of 11 cases who suffered carotid rupture treated in our hospital from Nov. 1989 to May 2004 were retrospectively analyzed. The procedure of ligation the ruptured carotid artery was performed immediately. All the cases were with recurrence of the cancer, including hypopharyngeal carcinoma 1 case, nasopharyngeal carcinoma 1 case, esophageal cancer 2 cases, laryngeal carcinoma 4 cases, buccal carcinoma 1 case and thyroid carcinoma 2 cases. Among these cases, 9 patients had history of radiotherapy with maximal dose of 130Gy, 7 patients had pharyngeal fistula. Carotid pressure of the distal stump was measured in 4 cases. RESULTS There were 10 common carotid arteries and 3 internal carotid arteries ligated respectively. The ratio of carotid pressure of the distal stump to radial arterial blood pressure was over 50 % in all measured cases. The common carotid artery was ligated in 1 patient with laryngeal carcinoma who suffered carotid arteriorhexis and no cerebral ischemia occurred. Eighteen days later, distal cartoid stump ruptured again, the external carotid artery and internal carotid artery were ligated respectively. Six hours later, mild hemiparalysis occurred in this patient. No complications occurred in other patients. CONCLUSION In patients with advanced head and neck cancer, their carotid arteries were compressed and invaded gradually by tumor, compensation of cerebral blood flow had been established in most patients when carotid arteriorrhexis happened. Carotid ligation was a feasible, emergent operation to save the life of the patients. Measure thecarotid pressure of the distal stump was helpful to select the treatment methods and could predict the prognosis.