鼻咽癌放疗后颈动脉狭窄的临床分析

The clinical study of carotid stenosis after radiotherapy in nasopharyngeal carcinoma

背景与目的:放射治疗是治疗头颈部恶性肿瘤主要手段之一。通过放疗以及放疗参与的多学科综合治疗能使约半数头颈部恶性肿瘤患者获得长期生存的机会。然而,放疗是否会造成颈部动脉血管的改变进而造成颈动脉狭窄,特别是鼻咽癌患者,放疗是否会造成此类损伤及损伤程度值得临床观察。本研究旨在探讨鼻咽癌放疗对颈动脉损伤的状况。方法:分析在复旦大学附属肿瘤医院接受放疗且生存达3年以上的鼻咽癌患者(研究组)与初治尚未接受放疗的鼻咽癌患者(对照组)的颈动脉狭窄状态,观察放疗后颈动脉损伤程度及影响其发生的临床因素。所有入组患者鼻咽部病理证实为低分化鳞癌。采用彩色多普勒超声检测患者双侧颈部血管情况,主要观察指标有血管内径、收缩期峰值流速及舒张末期血流速度。结果:研究组患者发生血管狭窄的情况比对照组更加明显和普遍,分别为80.0%和20.0%(P<0.001),其中以颈总动脉及颈内动脉发生狭窄的情况更为常见[颈总动脉(70.0%:20.0%,P<0.001);颈内动脉(63.3%:10.0%,P<0.001);颈外动脉(30.0%:3.3%,P=0.015)]。有意义的狭窄情况仅出现在研究组人群中(颈总动脉36.7%、颈内动脉23.3%、颈外动脉10.0%)。结论:接受颈部放疗后生存3年以上的鼻咽癌患者,放疗后的颈动脉狭窄是常见临床现象。狭窄多见于颈总动脉和颈内动脉。

Background and purpose：Radiotherapy is the main method to manage head and neck tumors.About half of the patients with malignant tumor in head and neck could obtain long term survival through radiotherapy or other therapy combined with radiotherapy.However,it is necessary to clinically detect whether carotid stenosis is a major sequela of head and neck irradiation,especially in long term survivors such as patients with nasopharyngeal carcinoma.We analyzed this injury and the degree of carotid stenosis,and its related factors to provide information to reduce and delay the incidence of this injury.Methods：We analyzed the degree of arterial stenosis of the nasopharyngeal carcinoma patients who received radiotherapy and had survived more than three years in Cancer Hospital Fudan University,compared with newly diagnosed as nasopharyngeal carcinoma before radiotherapy.The degree of carotid artery injury was observed and the clinical factors which affect its occurrence and development.All patients were low differentiated squamous cell carcinoma confirmed by pathology.All patients were examined with color doppler ultrasound to detect the carotid artery.The main end points were the diameter of carotid artery,the peak systolic and end diastolic velocities.Results：Arterial stenosis was more common in the reserch group than the control group （80% vs 20%,P〈0.001）.The common and internal carotid arteries were most commonly involved （70% vs 20%,P〈0.001;63.3% vs 10%,P〈0.001）,followed by the external carotid artery （30% vs 3.3%,P=0.015）.Significant stenosis was only found in the research group,common carotid arteries 36.7%,internal carotid arteries 23.3%,external carotid arteries10%.Conclusion：This study showed that radiation could cause significant carotid stenosis in nasopharyngealcarcinoma patients who had received radiotherapy more than 3 years previously.Carotid stenosis developed more frequently in the common carotid artery and internal carotid artery on the side that had received radiotherapy.