头颈部肿瘤难治性出血的急诊介入栓塞治疗

Emergency interventional embolization for the management of intractable tumor bleeding in head and neck cancer

目的探讨介入栓塞对头颈部肿瘤难治性出血的急诊治疗价值。方法2017年2月至2019年2月中国医学科学院肿瘤医院介入治疗科采用介入栓塞术治疗21例头颈部肿瘤难治性出血患者,回顾性分析其肿瘤治疗史、出血史、血管造影表现、介入栓塞技术成功率、临床成功率和并发症情况。结果21例患者造影阳性率为100%(21/21),其中表现为异常肿瘤染色11例,造影剂外溢5例,假性动脉瘤2例,血管畸形2例,颈外动脉起始部破裂1例。1例颈动脉破裂患者转入综合性医院治疗,余20例患者共行22次介入栓塞治疗,技术成功率为100%(22/22)。4例患者在30 d内发生再出血,临床成功率为80.0%(16/20)。5例(25.0%)患者出现轻度颌面部疼痛,无严重并发症发生。结论急诊介入栓塞治疗头颈部肿瘤难治性出血安全、有效。

Objective To evaluate emergency interventional embolization in treating intractable tumor bleeding in head and neck cancer.Methods From February 2017 to February 2019,a total of 21 patients underwent emergency interventional embolization for the management of intractable tumor bleeding in head and neck cancer in Cancer Hospital,Chinese Academy of Medical Sciences.The tumor treatment history,bleeding history,angiography performance,technical success rate,clinical success rate and complications were retrospectively analyzed.Results The positive rate of angiography was 100%(21/21).Selective angiogram revealing abnormal tumor staining in 11 cases,contrast media extravasation in 5 cases,pseudoaneurysm in 2 cases,arteriovenous malformation in 2 cases and external carotid artery rupture in 1 case.One patient with carotid rupture was transferred to a general hospital for treatment.The remaining 20 patients received a total of 22 times of interventional embolization.The technical success rate was 100%(22/22).Recurrence occurred in 4 patients within 30 days,and the clinical success rate was 80%(16/20).Mild maxillofacial pain occurred in 5 patients(25.0%)and no serious complications occurred.Conclusion Emergency interventional embolization is safe and effective for the management of intractable tumor bleeding in head and neck cancer.