支架成形术治疗鼻咽癌放疗后颈内动脉狭窄的价值

THE VALUE OF STENTING IN THE TREATMENT OF INTERNAL CAROTID ARTERY STENOSIS AFTER RADIOTHERAPY FOR NASOPHARYNGEAL CARCINOMA

目的探讨支架成形术治疗鼻咽癌放疗后颈内动脉狭窄的价值。方法选择2010年1月—2015年8月本院收治的鼻咽癌放疗后颈部血管狭窄病人80例,按照随机数字表法分为观察组与对照组两组,每组各40例。观察组实施颈内动脉支架成形术治疗,对照组实施药物保守治疗,随访6个月,比较两组治疗成功率及治疗前后血管彩色多普勒超声检查结果及近中期并发症。结果观察组血管再通率显著高于对照组(χ2=48.535,P<0.05)。观察组发生脑出血、血管痉挛和血栓脱落的总比例显著低于对照组(χ2=8.674,P<0.05)。随访6个月内,观察组发生脑供血不足及缺血性脑卒中的比例显著低于对照组(χ2=17.202、16.529,P<0.05)。治疗后观察组病变侧颈动脉收缩期和舒张期血流速度均慢于治疗前(t=9.762、16.971,P<0.05);血流阻力低于治疗前(t=26.000,P<0.05);治疗后观察组病变侧颈动脉收缩期和舒张期血流速度均慢于对照组(t=8.677、16.971,P<0.05);血流阻力低于对照组(t=24.000,P<0.05)。结论颈动脉支架成形术治疗鼻咽癌放疗后颈部血管狭窄,能有效开通狭窄血管,且治疗相关并发症少,临床效果可靠。

Objective To evaluate the value of artery stenting in the treatment of internal carotid stenosis（ICS）after radiotherapy for nasopharyngeal carcinoma（NPC）. Methods Eighty patients with cervical stenosis after radiotherapy for NPC treated in our hospital-during January 2010—August 2015-were selected and evenly randomized to observation group and control group.The patients in the observation group were treated with carotid angiography and stenting,and those in the control group were offered drug conservative treatmen.A follow-up of six months was conducted.The success rate of treatment,the results of vascular color Doppler ultrasonography-before and after treatment-as well as recent and mid-term complications bwtenn the two groups were compared. Results The rate of recanalization in the observation group was significantly higher than that in the control group（χ2=48.535,P〈0.05）.The total proportion of cerebral hemorrhage,vasospasm and thrombus detachment in the observation group was significantly lower than that in the control group（χ2=8.674,P〈0.05）.During the follow-up period of six months,the proportion of cerebral insufficiency and ischemic stroke in the observation group was significantly lower than that in the control group（χ2=17.202,16.529;P〈0.05）.After treatment,the diseased-side carotic artery systolic and diastolic blood flow velocity was slower than before treatment（t=9.762,16.971;P〈0.05）,the blood flow resistance was lower than that before treatment（t=26.000,P〈0.05）.After treatment,the systolic and diastolic blood flow velocity of the affected-side carotic artery was slower（t=8.677,16.971;P〈0.05）,and the blood flow resistance was lower than that of the control group（t=24.000,P〈0.05）.Conclusion Carotid stenting angioplasty for cervical stenosis after radiotherapy for nasopharyngeal carcinoma can effectively open the narrow blood vessels with few treatment-related complications and reliable clinical effectiveness.