Wurm J, Göde U, Fucak A
Klinik und Poliklinik für Hals-Nasen-Ohrenkranke (Direktor: Prof. Dr. M.E. Wigand), Universität Erlangen-Nürnberg.
HNO. 2000 Jan;48(1):22-7. doi: 10.1007/s001060050004.
Life threatening hemorrhage in patients with malignant tumours of the head and neck area are often, as a result of tumour infiltration, postoperative anatomical changes, infection and radiological necrosis, difficult to control. One option for prophylaxis and treatment is the ligature of the external (ECA) or common carotid artery (CCA) and superior thyroid artery (STA). 52 patients were examined in a retrospective study to determine both the hazards and the therapeutic use of the procedure. The external carotid artery (ECA) was ligated prophylactically during the operative procedure of tumour resection and neck dissection in 25 patients. In 27 cases closure of the ECA, CCA or ECA and STA was carried out as an emergency procedure for acute hemorrhage following completed primary treatment (operation, primary or postoperative radiation or radiochemotherapy). There was no postoperative hemorrhage after prophylactic ligature of the ECA. One patient with multiple cardiovascular diseases suffered from an ipsilateral cerebral infarction 1 year after operation. In 6 of 9 patients and in all 3 patients, in whom ligature of the CCA or ECA and STA respectively was carried out as an emergency procedure, severe neurological complications up to an apallic syndrome occurred. The number of deaths due to acute hemorrhage was considerably smaller among those patients with prophylactic ligature of the ECA performed during operative procedure of tumor resection and neck dissection. In addition there were much less unfavourable courses in the sequence of prophylactic closure of the ECA than observed after ligating the CCA or ECA and STA in an emergency situation.
由于肿瘤浸润、术后解剖结构改变、感染及放射性坏死，头颈部恶性肿瘤患者危及生命的出血往往难以控制。预防和治疗的一种选择是结扎颈外动脉（ECA）或颈总动脉（CCA）以及甲状腺上动脉（STA）。在一项回顾性研究中，对52例患者进行了检查，以确定该手术的风险和治疗用途。在25例患者的肿瘤切除和颈部清扫手术过程中，预防性结扎颈外动脉（ECA）。在27例患者中，在完成初次治疗（手术、初次或术后放疗或放化疗）后，作为急性出血的紧急手术，对颈外动脉、颈总动脉或颈外动脉和甲状腺上动脉进行了结扎。预防性结扎颈外动脉后未发生术后出血。1例患有多种心血管疾病的患者在术后1年发生同侧脑梗死。在分别作为紧急手术进行颈总动脉或颈外动脉和甲状腺上动脉结扎的9例患者中的6例以及所有3例患者中，发生了严重的神经并发症，直至出现无动性缄默综合征。在肿瘤切除和颈部清扫手术过程中进行颈外动脉预防性结扎的患者中，因急性出血导致的死亡人数明显较少。此外，与在紧急情况下结扎颈总动脉或颈外动脉和甲状腺上动脉后观察到的情况相比，颈外动脉预防性结扎后的不良病程要少得多。
