颅外-颅内血管搭桥术在鼻咽癌放疗后颈内动脉爆裂治疗中的应用

Extracranial/intracranial vascular bypass to control carotid artery blowout in postirradiated nasopharyngeal carcinoma patients

目的:总结分析颅外-颅内血管搭桥术治疗鼻咽癌患者放疗后颈内动脉爆裂大出血的效果。方法:回顾性分析9例鼻咽癌放疗后出现颈内动脉爆裂并接受颅外-颅内血管搭桥手术患者的临床资料,分析颅外-颅内血管搭桥术围手术期卒中和死亡率、生存时间、总体生存率及再出血率。结果:9例鼻咽癌放疗后患者平均年龄53.5岁,病理类型均为非角化性鳞状细胞癌,未分化型,Ⅳ期;9例患者均为颈内动脉出血,出血部位岩骨段7例,颈段2例;其中Ⅰ型威胁型出血3例(33.3%),Ⅱ型濒临型出血2例(22.2%),Ⅲ型急性出血4例(44.45%);所有患者均行颅外-颅内血管搭桥术,平均随访时间为16.7个月,未出现围手术期死亡和卒中;中位总生存时间为22.1个月,90 d、1年和2年生存率分别为100.0%、75.0%和30.0%。结论:鼻咽癌放疗后颈内动脉爆裂大出血患者,能够较安全地通过颅外-颅内血管搭桥术治疗,获得较长的生存时间。

Objective:To summarize and analyze the effect of extracranial/intracranial vascular bypass in the treatment of internal carotid artery burst hemorrhage after radiotherapy for nasopharyngeal carcinoma(NPC).Methods:A retrospective analysis of the data of 9 patients with nasopharyngeal carcinoma and carotid artery blowout syndrome(CBS)who underwent extracranial/intracranial vascular bypass.Collected patient demographics,treatment course and dose of radiotherapy,analyze the effect of extracranial/intracranial vascular bypass on the prognosis of patients with internal carotid artery burst hemorrhage,including perioperative stroke and death,overall survival rate,and rebleeding rate.Results:Nine patients were included in the study.The average age is 53.5 years.The pathological types were all non-keratinizing squamous cell carcinoma,undifferentiated,stageⅣ;7 cases of local NPC recurrence,2 cases of skull base osteonecrosis;all 9 cases had internal carotid artery hemorrhage,including 7 cases of petrous carotid artery and 2 cases of cervical carotid artery;3 cases of typeⅠthreatened CBS(33.3%),2 cases of typeⅡimpending CBS(22.2%),and 4 cases of typeⅢacute CBS(44.45%).All patients underwent extracranial/intracranial vascular bypass surgery,and there were no perioperative deaths and strokes.The mean follow-up was 16.7 months.The median overall survival time of the patients was 22.1 months and the 90-day,1-year and 2-year survival rates were 100.0%,75.0%and 30.0%,respectively.Conclusion:Patients with internal carotid artery burst hemorrhage after radiotherapy for nasopharyngeal carcinoma can be safely treated by extracranial/intracranial vascular bypass surgery and obtain a longer survival rate.