带覆膜支架的颅内颈动脉植入术治疗累及颈动脉的晚期头颈部鳞状细胞癌的可行性与安全性：一项初步研究。
Feasibility and safety of intracranial carotid implantation with covered stents for advanced head and neck squamous cell carcinoma involving the carotid artery: A preliminary investigation.
作者信息
Zhang Hai-Dong, Sun Kai, Gong Shan-Chun, Liu Kai, Lyu Xian-Jun, Yu Zhen-Kun
机构信息
School of Medicine Southeast University Nanjing China.
Department of Otorhinolaryngology and Head and Neck Surgery, BenQ Medical Center The Affiliated BenQ Hospital of Nanjing Medical University Nanjing China.
出版信息
World J Otorhinolaryngol Head Neck Surg. 2024 Mar 31;11(1):37-44. doi: 10.1002/wjo2.174. eCollection 2025 Mar.
OBJECTIVE
The aim of this study was to assess the feasibility and safety of implanting covered stents in cases of advanced head and neck squamous cell carcinoma (ASCCHN) where the carotid artery was involved.
METHODS
A total of 30 patients (29 males and one female) were included in this study, with ages ranging from 40 to 79 years. Among these patients, 28 patients had received radiotherapy and 17 received subsequent adjuvant therapy, while one was receiving treatment for the first time. Eighteen were treated with covered stent implantation in conjunction with surgery, and the remaining 12 received stent implantation alone. The study evaluated and compared the stent implantation's success rate, overall survival (OS), and associated complications.
RESULTS
Successful implantation of covered stents was achieved in all 30 cases. No instances of significant hemorrhage or thromboembolic cerebral infarction occurred during surgery. Of the patients in the salvage surgical group, 15 underwent complete tumor resection with a success rate of 83.3% (15/18), of which four experienced tumor recurrence with a local recurrence rate of 26.7% (4/15). The OS rates at 6 months for all patients, the salvage surgical group, the 15 patients with complete tumor resection, and the nonsurgical group were 64.0%, 66.8%, 75.5%, and 58.6%, respectively. At 12 months, the OS rates were 21.4%, 29.3%, 43.2%, and 11.8%, respectively. Notably, the OS of the 15 patients who underwent complete tumor resection was significantly higher than that of the 12 patients who received stent implantation alone ( = 0.044). All cerebrovascular accidents occurred in patients with radiotherapy history, and subsequent adjuvant therapy had no significant effect on the OS time in the salvage surgical and nonsurgical groups ( = 0.935; = 0.526).
CONCLUSION
In cases of ASCCHN involving the carotid artery, the implantation of covered stents is a safe and feasible procedure.
目的
本研究旨在评估在晚期头颈部鳞状细胞癌（ASCCHN）累及颈动脉的病例中植入覆膜支架的可行性和安全性。
方法
本研究共纳入30例患者（29例男性和1例女性），年龄在40至79岁之间。在这些患者中，28例接受过放疗，17例接受了后续辅助治疗，1例为首次接受治疗。18例患者接受了覆膜支架植入联合手术治疗，其余12例仅接受了支架植入。本研究评估并比较了支架植入的成功率、总生存期（OS）及相关并发症。
结果
30例患者均成功植入覆膜支架。手术过程中未发生严重出血或血栓栓塞性脑梗死病例。在挽救性手术组患者中，15例实现了肿瘤完全切除，成功率为83.3%（15/18），其中4例出现肿瘤复发，局部复发率为26.7%（4/15）。所有患者、挽救性手术组、15例肿瘤完全切除患者及非手术组在6个月时的OS率分别为64.0%、66.8%、75.5%和58.6%。在12个月时，OS率分别为21.4%、29.3%、43.2%和11.8%。值得注意的是，15例实现肿瘤完全切除患者的OS显著高于仅接受支架植入的12例患者（P = 0.044）。所有脑血管意外均发生在有放疗史的患者中，后续辅助治疗对挽救性手术组和非手术组的OS时间无显著影响（P = 0.935；P = 0.526）。
结论
在ASCCHN累及颈动脉的病例中，植入覆膜支架是一种安全可行的手术。
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