头颈部CT血管造影在鼻咽癌放疗后并发鼻出血介入术前评估中的应用

Application of head and neck CTA examined before interventional surgerys for assessment of epistaxis after radiotherapy to nasopharyngeal carcinoma

目的探讨头颈部CT血管造影(CTA)检查在鼻咽癌(NPC)放疗后出现难治性鼻出血行血管介入术前评估中的应用价值,从而指导临床快速有效的抢救鼻出血患者。方法回顾分析2016年1月至2021年1月期间在我院治疗的28例NPC放疗后合并难治性鼻出血患者的临床资料,所有患者术前均在确保气道通畅的前提下行头颈部CTA检查,根据CTA检查结果做好气道保护措施及确认手术方案,急诊行血管造影及栓塞责任血管治疗,并进一步观察止血率及抢救成功率。结果所有28例患者术前均完成头颈部CTA检查,其中发现颈内动脉假性动脉瘤(PSA)4例(右侧3例,左侧1例),颈外动脉PSA 1例,术前行气管插管4例,气管切开1例,所有患者均未出现出血窒息的情况。术中所有患者均行头颈部血管造影检查并成功完成介入栓塞治疗;其中1例因术中大量出血出现烦躁不能配合而暂停介入操作,经气管插管等处理后完成治疗。术后1周内1例合并PSA患者出现鼻出血再发,再次介入栓塞止血治疗。介入手术止血率96.4%,抢救成功率100%。结论术前常规快速的头颈部CTA检查,可帮助指导鼻咽癌患者术前的气道保护及术中更快速找寻责任血管并栓塞治疗,可帮助提高抢救成功率。

Objective To explore the application value of head and neck CT angiography(CTA)examined before interventional surgerys for assessment of intractable epistaxis after radiotherapy in patients with nasopharyngeal carcinoma(NPC),aimed at guiding the clinical rescue to patients with epistaxisrapidly and effectively.Methods From January 2016 to January 2021,the clinical data of 28 patients of intractable epistaxis after radiotherapy with NPC in our department were reviewed.All patients underwent preoperative head and neck CTA examined under the precondition of ensuring airway patency.According to the results of CTA examination,airway protection measures were taken and surgical plan was confirmed.Emergency angiography and embolization of responsible vessels were performed,and the hemostasis rate and rescue success rate were further observed.Results Head and neck CTA examinated pre-operation had been completed in all the 28 patients,among which pseudoaneurysm of the internal carotidartery was found in 4 cases(3 on the right side and 1 on the left),pseudoaneurysm of the external carotid artery in 1 case.Tracheal intubation was performed in 4 cases and tracheotomy in 1 case before operations.No cases of asphyxia due to massive epistaxis had been found.All patients had underwent head and neck angiography and interventional embolization successfully.The interventional operation was suspended due to massive epistaxis leading to impa-tiencein 1 case,then finished after endotracheal intubation and other treatments implemented.Within 1 week after the operation,1 case of recurrent epistaxis with pseudoaneurysm performed interventional embolization hemostasis again.The hemostasis rate of interventional operation was 96.4%,and the rescue success rate was 100%.Conclusion The results show that routinely rapid head and neck CTA examined preoperatively will contribute to guiding the airway protection pre-operation and finding the responsible vessels more quickly to implement embolotherapy during operation,which may be beneficial to improve the success rate of rescue.