放射治疗后鼻咽癌患者单侧颈内动脉栓塞术后脑卒中及颅神经麻痹的相关因素分析

doi:10.6040/j.issn.1673-3770.0.2024.421

摘要/Abstract

摘要： 目的分析鼻咽癌患者放射治疗后行单侧颈内动脉(internal carotid artery, ICA)栓塞术后出现脑卒中及颅神经麻痹的相关因素,降低术后并发症的概率, 提高该类患者的生存质量。方法回顾性分析在2018年3月1日至2022年10月31日于南方医科大学第三附属医院神经外科进行单侧ICA栓塞的109例患者的临床资料,对其随访1个月。将有术后脑卒中或颅神经麻痹症状的患者定义为有症状组(17例),其余为无症状组(92例),对性别、年龄、体质量指数(body mass index, BMI)、血压、术前血红蛋白、同侧ICA情况、对侧ICA是否狭窄、眼动脉是否代偿到大脑中动脉、闭塞节段和闭塞侧别等相关因素进行Logistic回归分析。结果有症状组和无症状组在性别、年龄、BMI、对侧ICA是否狭窄、闭塞侧别及球囊闭塞试验(balloon occlusion test, BOT)方面组间差异无统计学意义(P均>0.05),而在闭塞节段(P=0.001)、闭塞侧颈内动脉情况(狭窄、正常及存在假性动脉瘤)(P=0.010)、术前血红蛋白(P=0.024)与术后出现脑卒中/颅神经麻痹方面差异具有统计学意义。血红蛋白升高(OR=0.971)为保护因素,闭塞至海绵窦段(OR=2.292)为危险因素。结论对于需要闭塞颈内动脉的鼻咽癌患者,应尽量维持术前血红蛋白≥90 g/L;闭塞节段在海绵窦段以下可以减少术后颅神经麻痹症状,尤其是动眼神经及外展神经麻痹症状。

关键词: 鼻咽癌, 颅神经麻痹, 脑卒中, 闭塞

Abstract: Objective To analyze the factors related to stroke and cranial nerve paralysis following unilateral internal carotid artery(ICA)embolization in patients with nasopharyngeal carcinoma after radiotherapy, in order to reduce the probability of postoperative complications and improve the quality of life for these patients. Methods A retrospective analysis was conducted on the clinical data of 109 patients who underwent unilateral ICA embolization in the Department of Neurosurgery at the Third Affiliated Hospital of Southern Medical University between March 1, 2018, and October 31, 2022. These patients were followed up for one month. Patients with postoperative symptoms of stroke or cranial nerve paralysis were defined as the symptomatic group(17 cases), while the rest were classified as the asymptomatic group(92 cases). Logistic regression analysis was performed on factors such as gender, age, body mass index(BMI), blood pressure, preoperative hemoglobin levels, the status of the ipsilateral ICA, whether the contralateral ICA was stenosed, whether the ophthalmic artery compensated for the middle cerebral artery, the occlusion segment, and the side of occlusion. Results There were no statistically significant differences between the symptomatic and asymptomatic groups in terms of gender, age, BMI, whether the contralateral ICA was stenosed, the side of occlusion, or the balloon occlusion test(BOT)(all P>0.05). However, there were statistically significant differences in the occlusion segment(P=0.001), the status of the occluded ICA(stenosis, normal, or presence of a pseudoaneurysm)(P=0.010), and preoperative hemoglobin levels(P=0.024)with respect to the occurrence of postoperative stroke/cranial nerve paralysis. Elevated hemoglobin levels(OR=0.971)were identified as a protective factor, while occlusion extending to the cavernous sinus segment(OR=2.292)was identified as a risk factor. Conclusion For patients with nasopharyngeal carcinoma requiring ICA occlusion, preoperative hemoglobin levels should be maintained at ≥90 g/L. Occlusion at segments below the cavernous sinus can reduce postoperative symptoms of cranial nerve paralysis, particularly oculomotor and abducens nerve paralysis.

Key words: Nasopharyngeal carcinoma, Cranial nerve paralysis, Stroke, Occlusion

中图分类号:

R651.1

王思权,朱洪申,张晓斌,赵洲洋,马跃,杨一梅,黄理金. 放射治疗后鼻咽癌患者单侧颈内动脉栓塞术后脑卒中及颅神经麻痹的相关因素分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 19-25.

WANG Siquan, ZHU Hongshen, ZHANG Xiaobin, ZHAO Zhouyang, MA Yue, YANG Yimei, HUANG Lijin. Analysis of factors associated with stroke and cranial nerve palsy after unilateral internal carotid artery embolization in patients with nasopharyngeal carcinoma after radiotherapy[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(4): 19-25.

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