鼻咽癌放疗后大出血15例诊疗体会△

目的 探讨鼻咽癌(NPC)患者放疗后大出血的原因以及可行的治疗和挽救措施。方法 回顾分析2012年1月~2018年10月就诊于我科的15例NPC放疗后出血患者的临床资料。所有患者均予以心电监护、补液扩容、鼻腔填塞等处理。8例予输血,4例行气管插管。9例行数字减影血管造影术(DSA),其中5例提示颈内动脉假性动脉瘤(PSA)形成,1例行岩骨段覆膜支架置入,1例在外院行颈内动脉闭塞术,其余3例未行治疗。结果 15例患者中死亡5例,自动出院4例(2例深度昏迷),好转出院6例。行覆膜支架置入者术后好转出院,随访提示术后2个月死亡。行颈内动脉闭塞术者术后肢体偏瘫,经康复治疗后改善。未行治疗者均死亡。4例患者行颌内动脉栓塞术,3例好转出院,1例死亡。结论 NPC放疗后大出血病情凶险,预后较差。出血部位可为颌内动脉出血及颈内动脉PSA形成。鼻腔填塞是止血的首选措施,鼻咽部填塞及DSA为可选方法。

Clinical analysis of 15 cases of epistaxis after radiotherapy for nasopharyngeal carcinoma

Objective To explore the causes of epistaxis after radiotherapy in patients with nasopharyngeal carcinoma and the feasible treatment and remedial measure. Methods The clinical data of 15 patients with epistaxis after radiation therapy for nasopharyngeal carcinoma who received treatment from Jan. 2012 to Oct. 2018 in Northern Jiangsu People's Hospital were collected for retrospective analysis. All patients were treated with electrocardiogram monitoring, fluid infusion and nasal packing. Eight patients were given blood transfusions and four cases were given endotracheal intubation. Digital subtraction angiography (DSA) was performed in 9 cases, 5 of which suggested the formation of pseudoaneurysm of the internal carotid artery. One patient underwent implantation of a stent graft in internal carotid artery. Another patient underwent embolization of internal carotid artery. The remaining 3 patients were not treated. Results Among the 15 patients, 5 cases died, 4 cases were discharged automatically (2 were in deep coma), and 6 cases were discharged with improvement. The patient treated with stent graft was discharged with improvement but died 2 months after the surgery. Patient treated with embolization of internal carotid artery had postoperative hemiplegia and improved after rehabilitation. Those who did not receive treatment died. Four patients were treated with internal maxillary artery embolization, 3 cases were discharged and 1 case died. Conclusions Epistaxis after radiotherapy for nasopharyngeal carcinoma is dangerous and fatal. The bleeding site can be internal maxillary artery hemorrhage or the formation of pseudoaneurysm of internal carotid artery. Nasal packing is the first choice of epistaxis and nasopharyngeal packing and DSA might be the optional methods.