Lam Jacky Wai-Kei, Chan Jimmy Yu-Wai, Lui Wai-Man, Ho Wai-Kuen, Lee Raymond, Tsang Raymond King-Yin
Division of Otorhinolaryngology -, Head and Neck Surgery, Hong Kong.
Laryngoscope. 2014 Oct;124(10):2292-6. doi: 10.1002/lary.24721. Epub 2014 May 30.
OBJECTIVES/HYPOTHESIS: Massive epistaxis due to ruptured pseudoaneurysm of the internal carotid artery (ICA) is an often fatal complication of radiation treatment for patients with nasopharyngeal carcinoma. We review the clinical characteristics and predictors of survival in patients suffering from this serious complication after radiotherapy.
Retrospective case series.
Clinical records and radiological investigations of postirradiated NPC patients with ICA pseudoaneurysm diagnosed with digital subtraction angiography in Queen Mary Hospital from January 2003 to December 2012 were reviewed. Risk factors analyzed for survival included gender, size of initial tumor, history of second course of radiotherapy, history of previous maxillary swing nasopharyngectomy, presence of persistent disease, successful initial hemostasis, successful airway control, and endovascular treatment.
Twenty-six were included in the analysis. Twenty-three patients underwent endovascular treatment, and 20 (87%) had successful control of the bleeding. Eighteen (69%) patients survived. Univariate analysis showed that successful temporary control of bleeding and airway control were associated with survival.
Prompt bleeding control and airway management is necessary to improve survival. Endovascular treatment is a good definitive treatment option with a high success rate.
目的/假设：颈内动脉假性动脉瘤破裂导致的大量鼻出血是鼻咽癌患者放射治疗中一种常致命的并发症。我们回顾了放疗后出现这种严重并发症患者的临床特征及生存预测因素。
回顾性病例系列研究。
回顾了2003年1月至2012年12月在玛丽医院经数字减影血管造影诊断为颈内动脉假性动脉瘤的放疗后鼻咽癌患者的临床记录及影像学检查。分析的生存危险因素包括性别、初始肿瘤大小、二次放疗史、既往上颌骨摆动式鼻咽癌切除术史、疾病持续存在、初始止血成功、气道控制成功及血管内治疗。
26例纳入分析。23例患者接受了血管内治疗，20例（87%）出血得到成功控制。18例（69%）患者存活。单因素分析显示，出血的成功临时控制及气道控制与生存相关。
迅速控制出血及气道管理对于提高生存率很有必要。血管内治疗是一种成功率高的良好确定性治疗选择。
