血管内支架成形术治疗鼻咽癌放疗后颈内动脉开口狭窄的效果分析

Effect of endovascular stenting in the treatment of internal carotid artery stenosis after radiotherapy for nasopharyngeal carcinoma

目的探讨血管内支架成形术治疗鼻咽癌放疗后颈内动脉开口狭窄患者的临床效果。方法选取62例2015-01—2019-12梧州市工人医院治疗的鼻咽癌放疗后颈内动脉开口狭窄患者,对照组(n=31)行保守治疗,研究组(n=31)行颈内动脉支架成形术治疗,回顾分析2组患者血管再通、近期及远期并发症、血管血流变化情况等。结果研究组血管再通率93.55%,显著高于对照组的16.13%(χ~2=37.512,P<0.05);研究组患者脑出血、血管痉挛、血栓脱落近期并发症以及脑供血不足、缺血性脑卒中远期并发症发生率均显著低于对照组(P<0.05);研究组治疗后病变侧颈动脉收缩期及舒张期血流速度均显著慢于对照组,血流阻力显著小于对照组(t=10.809、3.655、9.959,P<0.05);与对照组比较,研究组患者治疗后1周的Vs、Vm、PI、Vd数值均显著更高,RI值显著更低(t=10.255、7.595、10.599、2.332、8.737,P<0.05)。结论鼻咽癌放疗后颈内动脉开口狭窄患者行血管内支架成形术治疗,可获得更高血管再通率,减少近期及远期并发症,提高血管血流速度,有助于远端脑组织低灌注现象的改善,提高总体效果。

Objective patients with internal carotid artery stenosis after radiotherapy.Methods Sixty-two patients with internal carotid artery stenosis after radiotherapy for nasopharyngeal carcinoma treated in our hospital from January 2015 to December 2019 were divided into two groups,the control group(n=31)received conservative treatment,the study group(n=31)underwent internal carotid artery stenting,recanalization,short-term and long-term complications and changes of blood flow were analyzed retrospectively.Results The vascular recanalization rate in the study group was 93.55%,which was significantly higher than that in the control group(16.13%,χ~2=37.512,P<0.05).The recent complications of cerebral hemorrhage,vasospasm,thrombus shedding,cerebral insufficiency and long-term complications of ischemic stroke in the study group were significantly lower than those in the control group(P<0.05).After treatment,the systolic and diastolic blood flow velocity of the lesion side of carotid artery in the study group was significantly slower than that in the control group,and the blood flow resistance was significantly lower than that in the control group(t=10.809,3.655,9.959,P<0.05).Compared with the control group,the values of Vs,Vm,PI and Vd were significantly higher and RI was significantly lower in the study group one week after treatment(t=10.255,7.595,10.599,2.332,8.737,P<0.05).Conclusion Stent angioplasty was performed in patients with internal carotid artery stenosis after radiotherapy for nasopharyngeal carcinoma,can achieve higher vascular recanalization rate,reduce short-term and long-term complications,improve blood flow velocity,and help to effectively improve the phenomenon of low perfusion of distal brain tissue and improve the overall curative effect.