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, stage Ⅳ; 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 type Ⅱ impending CBS(22.2%), and 4 cases of type Ⅲ acute 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.
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。.
Keywords: carotid blowout syndrome; extracranial/intracranial vascular bypass; nasopharyngeal neoplasms; radiotherapy.
Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.