鼻咽癌放疗后颈部血管假性动脉瘤患者的临床特征分析
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摘要
目的:分析比较鼻咽癌放疗后大出血患者有无颈部血管假性动脉瘤(PSA)形成的临床特征,总结颈部PSA患者的临床征象,为提高救治成功率提供依据。方法:收集我院因鼻咽癌放疗后大出血行数字减影血管造影术(DSA)明确出血责任血管患者32例,根据有无颈部PSA形成分为动脉瘤组(PSA组)和非动脉瘤组(非PSA组),分析比较2组的性别、年龄、肿瘤复发、二程放疗、放疗后鼻咽部手术史、出血与放疗结束的间隔时间、介入治疗前开放气道等临床特征。结果:PSA组患者的肿瘤复发率为80%(12/15)、二程放疗率为60%(9/15),明显高于非PSA组;其出血时间距放疗结束时间平均为36.5个月,较非PSA患者(106.7个月)明显缩短。结论:颈部PSA患者的高危临床特征包括:(1)鼻咽癌肿瘤复发;(2)有二程放疗史;(3)出血时间距放疗结束时间较短,若为二程放疗结束,通常发生于数月至2年内。具有上述特征的患者,需要早期甄别,尽早行DSA明确颈部血管情况并进行有效的栓塞止血。
Objective:The aim of this study is to analyze the clinical features of the pseudoaneurysm of the cervical vascular in patients with nasopharyngeal carcinoma after radiotherapy,and to summarize the clinical signs of patients with cervical vascular aneurysm,and to provide a basis for improving the success rate of treatment.Method:Patients with hemorrhage disease were treated by digital subtraction angiography(DSA)after radiotherapy for nasopharyngeal carcinoma are included.According to the presence or absence of pseudoaneurysm(PSA),patients are divided to pseudoaneurysm group(PSA group)and non-pseudoaneurysm group(non-PSA group),analysis of gender,age,presence or absence of tumor recurrence,presence or absence of recurrent radiotherapy,history of nasopharyngeal surgery after radiotherapy,needed to open the airway before the interval therapy,time to the end of radiotherapy.Result:The rate of tumor recurrence was 80%(12/15)in patients with pseudoaneurysm and60%(9/15)in recurrent radiotherapy,which was significantly higher than that in patients with non-pseudular aneurysms.The average time to the end of radiotherapy is 36.5 months in patients with pseudoaneurysm,significantly shorter than non-pseudoaneurysm patients(106.7 months).Conclusion:The high-risk clinical features of patients with cervical vascular pseudoaneurysm include:(1)recurrence of nasopharyngeal carcinoma;(2)history of recurrent radiotherapy;(3)interval time is shorter between the hemorrhage and the end of radiotherapy,usually taking place within a few months to two years after recurrent radiotherapy.Patients with the above characteristics need to be screened early,and the DSA should be used as early as possible to confirm the cervical vascular condition and effectively control the hemorrhage.
Objective:The aim of this study is to analyze the clinical features of the pseudoaneurysm of the cervical vascular in patients with nasopharyngeal carcinoma after radiotherapy,and to summarize the clinical signs of patients with cervical vascular aneurysm,and to provide a basis for improving the success rate of treatment.Method:Patients with hemorrhage disease were treated by digital subtraction angiography(DSA)after radiotherapy for nasopharyngeal carcinoma are included.According to the presence or absence of pseudoaneurysm(PSA),patients are divided to pseudoaneurysm group(PSA group)and non-pseudoaneurysm group(non-PSA group),analysis of gender,age,presence or absence of tumor recurrence,presence or absence of recurrent radiotherapy,history of nasopharyngeal surgery after radiotherapy,needed to open the airway before the interval therapy,time to the end of radiotherapy.Result:The rate of tumor recurrence was 80%(12/15)in patients with pseudoaneurysm and60%(9/15)in recurrent radiotherapy,which was significantly higher than that in patients with non-pseudular aneurysms.The average time to the end of radiotherapy is 36.5 months in patients with pseudoaneurysm,significantly shorter than non-pseudoaneurysm patients(106.7 months).Conclusion:The high-risk clinical features of patients with cervical vascular pseudoaneurysm include:(1)recurrence of nasopharyngeal carcinoma;(2)history of recurrent radiotherapy;(3)interval time is shorter between the hemorrhage and the end of radiotherapy,usually taking place within a few months to two years after recurrent radiotherapy.Patients with the above characteristics need to be screened early,and the DSA should be used as early as possible to confirm the cervical vascular condition and effectively control the hemorrhage.
引文
[1]张剑利,王跃建,陈伟雄.鼻咽癌放疗后鼻咽出血原因分析[J].临床耳鼻咽喉头颈外科杂志,2010,24(9):394-399.
[2]王飞,彭建辉,曹春华,等.鼻咽癌放疗后鼻咽部大出血21例原因及临床分析[J].现代医药卫生,2013,29(22):3432-3433.
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[4]李子晨,许鹏飞,容小明,等.鼻咽癌放疗后大出血的相关因素分析及治疗方法[J].中国肿瘤临床,2013,40(17):1059-1063.
[5]尧振兴,唐安洲,谢貌,等.鼻咽癌放疗后颈部血管假性动脉瘤诊疗进展[J].临床耳鼻咽喉头颈外科杂志,2016,30(11):919-921.
[6]CHRISTENSEN N P,SMITH D S,BARNWELL SL,et al.Arterial embolization in the management of posterior epistaxis[J].Otolaryngol Head Neck Surg,2005,133:748-753.
[7]GUSS J,COHEN M A,MIRZA N.Hard palate necrosis after bilateral internal maxillary artery embolization for epistaxis[J].Laryngoscope,2007,117:1683-1684.
[2]王飞,彭建辉,曹春华,等.鼻咽癌放疗后鼻咽部大出血21例原因及临床分析[J].现代医药卫生,2013,29(22):3432-3433.
[3]WONG G K,CHAN K K,YU S C,et al.Treatment of profuse epistaxis in patients irradiated for nasopharyngeal carcinoma[J].ANZ J Surg,2007,77:270-274.
[4]李子晨,许鹏飞,容小明,等.鼻咽癌放疗后大出血的相关因素分析及治疗方法[J].中国肿瘤临床,2013,40(17):1059-1063.
[5]尧振兴,唐安洲,谢貌,等.鼻咽癌放疗后颈部血管假性动脉瘤诊疗进展[J].临床耳鼻咽喉头颈外科杂志,2016,30(11):919-921.
[6]CHRISTENSEN N P,SMITH D S,BARNWELL SL,et al.Arterial embolization in the management of posterior epistaxis[J].Otolaryngol Head Neck Surg,2005,133:748-753.
[7]GUSS J,COHEN M A,MIRZA N.Hard palate necrosis after bilateral internal maxillary artery embolization for epistaxis[J].Laryngoscope,2007,117:1683-1684.