鼻咽癌放疗后肿瘤复发及颅底骨坏死引起颈内动脉破裂的治疗方案

doi:10.6040/j.issn.1673-3770.0.2024.228

摘要/Abstract

摘要： 目的探讨经鼻内镜手术治疗局部复发鼻咽癌或鼻咽癌放疗后颅底骨坏死的颈内动脉保护技巧和围术期处理策略。方法回顾性分析2019年1月至2023年12月于深圳市龙岗区耳鼻咽喉医院接受经鼻内镜下手术治疗的局部复发鼻咽癌及鼻咽癌颅底骨坏死患者临床资料,对病变邻近或累及颈内动脉病例的性别与年龄、病变部位及其与颈内动脉关系、病变切除情况、术中重要血管的保护方法、术后颈内动脉出血及处理、术后病情恢复情况等进行分析总结。结果共纳入患者47例,男女比例25∶22,平均(50.98±10.93)岁;其中复发组29例,病变侵犯颈内动脉9例;骨坏死组18例,病变侵犯颈内动脉6例。术后随访过程中,复发组5例患者术后手术邻近部位肿瘤复发,平均复发时间15个月;术后颈内动脉破裂出血发生率为6.9%,死亡率为10.34%。骨坏死组中1例患者术后7月再次发现骨坏死并再次行手术治疗;术后颈内动脉破裂出血发生率为5.6%,死亡率为11.11%。两组病例出血均发生于高位颈段颈内动脉,患者术前均发现病变已侵犯颈内动脉。结论对于鼻咽癌局部复发或放疗后颅底骨坏死,特别是邻近或累及颈内动脉者,术前需充分评估肿瘤范围及周围重要血管情况,制定相应的手术方案及处理方法;术中熟练掌握保护颈内动脉的手术技巧,注重对大血管进行保护,可提高手术安全性。

关键词: 局部复发鼻咽癌, 颅底骨坏死, 鼻内镜手术, 颈内动脉

Abstract: Objective To investigate the internal carotid artery protection techniques and perioperative management strategies of endoscopic surgery for local recurrent nasopharyngeal carcinoma or skull base osteonecrosis after radiotherapy for nasopharyngeal carcinoma. Methods The clinical data of patients with local recurrent nasopharyngeal carcinoma and skull base osteonecrosis of nasopharyngeal carcinoma who received endoscopic surgery at Department of Otolaryngology, Shenzhen Longgang Otolaryngology hospital from January 2019 to December 2023 were retrospectively analyzed. The gender and age of the patients near or involving the internal carotid artery were analyzed and summarized, the lesion site and its relationship with the internal carotid artery, the resection of the lesion, the protection methods of important blood vessels during the operation, the postoperative internal carotid artery bleeding and its management, and the postoperative recovery were analyzed and summarized. Results A total of 47 patients were included, with a male to female ratio of 25∶22 and an average age of 50.98±10.93 years. There were 29 cases of recurrence and 9 cases of internal carotid artery invasion. In the osteonecrosis group, the lesion invaded the internal carotid artery in 6 cases. During the postoperative follow-up, 5 patients in the recurrence group had tumour recurrence at the site adjacent to surgery, and the average recurrence time was 15 months. The incidence of postoperative internal carotid artery rupture bleeding was 6.9% and the mortality rate was 10.34%. In the osteonecrosis group, 1 patient was found to have recurrent osteonecrosis at 7 months after surgery and was treated again. The incidence of postoperative internal carotid artery rupture bleeding was 5.6% and the mortality was 11.11%. Bleeding occurred in the high internal carotid artery in both groups, and the lesions were found to have invaded the internal carotid artery before surgery. Conclusion For patients with local recurrence of nasopharyngeal carcinoma or with skull base osteonecrosis near or involving the internal carotid artery after radiotherapy, the extent of the tumour and surrounding major blood vessels should be fully evaluated before surgery, and the appropriate surgical protocols and management methods should be formulated. Surgical safety can be improved by mastering the surgical skills to protect the internal carotid artery and by paying attention to the protection of major blood vessels.

Key words: Local recurrent nasopharyngeal carcinoma, Skull base bone necrosis, Nasal endoscopic surgery, Internal carotid artery

中图分类号:

R739.63

王再兴,唐志元,李定波,石照辉,曾宪海,张秋航. 鼻咽癌放疗后肿瘤复发及颅底骨坏死引起颈内动脉破裂的治疗方案[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 49-58.

WANG Zaixing, TANG Zhiyuan, LI Dingbo, SHI Zhaohui, ZENG Xianhai, ZHANG Qiuhang. Treatment of internal carotid artery rupture caused by tumor recurrence and skull base osteonecrosis after radiotherapy for nasopharyngeal carcinoma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(4): 49-58.

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