复发鼻咽癌伴局部组织坏死及血管放射性损伤的脑血流重建一例

Cerebral blood flow reconstruction of recurrent nasopharyngeal carcinoma with local tissue necrosis and vascular radiation injury:a case report

侵犯颈内动脉的复发鼻咽癌在进行手术切除鼻咽部肿瘤组织时面临颈内动脉破裂大出血的风险,故准确、合理地评估脑血流代偿情况后闭塞患侧颈内动脉,是复发鼻咽癌治疗上的重要环节。本文报道1例侵犯颈内动脉的复发鼻咽癌合并锁骨下动脉闭塞、椎动脉盗血的血运重建病例,通过血管内介入治疗尝试开通右侧锁骨下动脉失败,随后应用腋-腋动脉旁路移植术解决了椎动脉盗血,评估脑血流代偿情况后,顺利、安全地栓塞受侵犯的右侧颈内动脉,无脑缺血发生,并完成了复发鼻咽癌的后续治疗。

Recurrent nasopharyngeal carcinoma(NPC)with internal carotid artery invasion is at risk of internal carotid artery rupture when resection of nasopharyngeal tumor tissue.Therefore,accurate and reasonable evaluation of cerebral blood flow compensation after occlusion of the affected internal carotid artery is an important link in the treatment of recurrent nasopharyngeal carcinoma.This paper reports blood flow reconstruction in a case of recurrent NPC with internal carotid artery invasion accompanied by subclavian artery occlusion and vertebral artery steal.After failure to recanalize the right subclavian artery through endovascular interventional therapy,the axillary artery bypass grafting was applied to solve the problem of vertebral artery steal.After evaluation of cerebral blood flow compensation again,the right internal carotid artery was successfully and safely embolized.No cerebral ischemia occurred,and the follow-up treatment of recurrent NPC was completed.