放射性鼻咽癌患者颈内动脉破裂的临床预测因素。
Clinical predictors of internal carotid artery blowout in patients with radiated nasopharyngeal carcinoma.
机构信息
Department of Otolaryngology - Head & Neck Surgery, National University Hospital, Singapore, Singapore.
Division of Interventional Radiology, Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore.
出版信息
Head Neck. 2021 Dec;43(12):3757-3763. doi: 10.1002/hed.26869. Epub 2021 Sep 24.
BACKGROUND
The primary objective is to identify clinical predictors of internal carotid artery (ICA) blowout in radiated nasopharyngeal carcinoma (NPC).
METHODS
Seventeen ICA blowouts, 14 external carotid artery (ECA) bleeds, and 60 controls were identified from January 1, 2007 to July 31, 2020. Multinomial logistic regression was performed to identify features predictive of ICA blowouts.
RESULTS
Headache was significantly more common among ICA blowouts than ECA bleeds and controls (58.8% vs. 7.1% vs. 6.7%, p < 0.001). The petrous skull base and sphenoid sinus lateral wall was eroded in all petrous and cavernous segment blowouts, respectively. Nasoendoscopy showing exposed clivus (OR 20.5, 95%CI 1.3-324.2) and computed tomography demonstrating skull base erosion (OR 17.8, 95%CI 1.0-311.0) were significantly associated with ICA blowouts compared to controls.
CONCLUSIONS
Findings of headache and skull base erosion on nasoendoscopy or imaging during NPC surveillance warrants prophylactic intervention to avoid an ICA blowout.
背景
本研究旨在确定放射性鼻咽癌（NPC）患者颈内动脉（ICA）破裂的临床预测因素。
方法
我们从 2007 年 1 月 1 日至 2020 年 7 月 31 日，共发现了 17 例 ICA 破裂、14 例颈外动脉（ECA）出血和 60 例对照。采用多项逻辑回归分析确定 ICA 破裂的预测特征。
结果
与 ECA 出血和对照组相比，ICA 破裂患者更常出现头痛（58.8%比 7.1%比 6.7%，p < 0.001）。所有岩骨段和海绵窦段的 ICA 破裂均伴有岩骨基底部和蝶窦外侧壁侵蚀。鼻内镜检查显示显露的斜坡（OR 20.5，95%CI 1.3-324.2）和 CT 显示颅底侵蚀（OR 17.8，95%CI 1.0-311.0）与 ICA 破裂显著相关，而与对照组相比。
结论
在 NPC 监测期间，头痛和鼻内镜或影像学显示颅底侵蚀的发现提示需要预防性干预以避免 ICA 破裂。
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