山东大学耳鼻喉眼学报 ›› 2019, Vol. 33 ›› Issue (2): 21-25.doi: 10.6040/j.issn.1673-3770.0.2019.071

• 专家笔谈 • 上一篇    下一篇

鼻咽癌外科治疗中的颈内动脉保护

王振霖*(),刘俊其   

  1. 首都医科大学宣武医院耳鼻咽喉头颈外科,北京 100053
  • 收稿日期:2019-02-20 出版日期:2019-03-20 发布日期:2019-03-28
  • 通讯作者: 王振霖 E-mail:wzl1812@163.com
  • 作者简介:王振霖,医学博士、博士后,主任医师,教授,博士生导师。首都医科大学宣武医院耳鼻咽喉头颈外科主任,首都医科大学耳鼻咽喉科学院副院长,首都医科大学慢性鼻炎和鼻窦炎临床诊疗与研究中心副主任。主要学术任职:中国医师协会耳鼻咽喉科医师分会委员、颅底外科学组副组长、青年委员会秘书长,中华医学会变态反应学分会鼻眼过敏性疾病学组委员,中国中西医结合学会耳鼻咽喉科专业委员会鼻颅底肿瘤及嗅觉专家委员会副主任委员,中国医疗保健国际交流促进会过敏科学分会常委,中国医学装备协会耳鼻咽喉头颈外科专业委员会委员,北京医学会耳鼻咽喉头颈外科分会委员,北京市中西医结合学会耳鼻咽喉头颈外科分会委员,美国耳鼻咽喉头颈外科协会会员,《中华耳鼻咽喉头颈外科杂志》《中国耳鼻咽喉颅底外科杂志》《中国耳鼻咽喉头颈外科杂志》等刊编委

Protection of the internal carotid artery during surgery for nasopharyngeal carcinoma

Zhenlin WANG*(),Junqi LIU   

  1. Department of Otolaryngology Head and Neck Surgery, Xuanwu Hospital Capital Medical University, Beijing 100053, China
  • Received:2019-02-20 Online:2019-03-20 Published:2019-03-28
  • Contact: Zhenlin WANG E-mail:wzl1812@163.com

摘要:

颈内动脉出血是晚期鼻咽癌患者较常见、最为严重的并发症,致死致残率极高。颈内动脉出血可发生于术中、术后或者放疗后。预防和处理颈内动脉出血是影响晚期鼻咽癌患者生存期和生活质量的重要课题。总结近年来国内外相关文献,分享预防和处理颈内动脉出血的经验,同时探讨保护颈内动脉同时行鼻咽颅底扩大切除术的治疗方案。

关键词: 鼻咽肿瘤, 并发症, 颈内动脉出血

Abstract:

Internal carotid artery bleeding is a common complication during or after surgery for nasopharyngeal carcinoma and may result in hemiplegia or death. Internal carotid artery bleeding can also occur after radiotherapy. Prevention and management of this complication are of utmost importance for patient survival and quality of life. This article reviews the recent advances and reports our experience in the management of internal carotid artery bleeding. We also discuss the surgical options for extended resection of the tumor.

Key words: Nasopharyngeal neoplasms, Complications, Internal carotid artery bleeding

中图分类号: 

  • R765

表1

复发患者的手术疗效"

作者 发表年 例数 3年/5年
生存率(%)
3年/5年
局控率(%)
邱前辉等[7] 2017 45 81.0/76.0
孙希才等[8] 2015 71 63.0/39.0 50.5/31.9
司勇锋等[9] 2010 46 -/72.0
Vlantis等[10] 2007 79 -/51.0 -/62.0
唐平章等[11] 2005 41 -/34.0
Wei等[12] 2003 109 -/54.0 -/69.0
King等[13] 2002 31 -/47.0 -/71.0
Hsu等[14] 2001 60 -/30.0 -/48.3
1 Wei KR , Zheng RS , Zhang SW , et al. Nasopharyngeal carcinoma incidence and mortality in China in 2010[J]. Chin J Cancer, 2014, 33 (8): 381- 387.
doi: 10.5732/cjc.014.10086
2 文译辉, 文卫平. 经鼻内镜对局部残留和复发鼻咽癌的手术切除[J]. 临床耳鼻咽喉头颈外科杂志, 2010, 24 (23): 1095- 1098.
doi: 10.3969/j.issn.1001-1781.2010.23.018
3 Xiao WW , Han F , Lu TX , et al. Treatment outcomes after radiotherapy alone for patients with early-stage nasopharyngeal carcinoma[J]. Int J Radiat Oncol Biol Phys, 2009, 74 (4): 1070- 1076.
doi: 10.1016/j.ijrobp.2008.09.008
4 Bian XH , Song T , Wu SX . Outcomes of xerostomia-related quality of life for nasopharyngeal carcinoma treated by IMRT: based on the EORTC QLQ-C30 and H &N35 questionnaires[J]. Expert Rev Anticancer Ther, 2015, 15 (1): 109- 119.
doi: 10.1586/14737140.2015.961427
5 Zhao CL , Chen J , Yu B , et al. Improvement in quality of life in patients with nasopharyngeal carcinoma treated with non-invasive extracorporeal radiofrequency in combination with chemoradiotherapy[J]. Int J Radiat Biol, 2014, 90 (10): 853- 858.
doi: 10.3109/09553002.2014.916579
6 Cao SM , Simons MJ , Qian CN . The prevalence and prevention of nasopharyngeal carcinoma in China[J]. Chin J Cancer, 2011, 30 (2): 114- 119.
doi: 10.5732/cjc.010.10377
7 邱前辉, 李娜, 张秋航, 等. 内镜手术治疗首诊局部晚期鼻咽癌的疗效分析[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52 (5): 365- 371.
doi: 10.3760/cma.j.issn.1673-0860.2017.05.009
QIU Qianhui , LI Na , ZHANG Qiuhang , et al. Clinical efficacy of endoscopic nasopharyngectomy for initially diagnosed advanced nasopharyngeal carcinoma[J]. Chinese JOurnal of Otorhinolaryngology Head and Neck Surgery, 2017, 52 (5): 365- 371.
doi: 10.3760/cma.j.issn.1673-0860.2017.05.009
8 孙希才, 刘娟, 王欢, 等. 内镜下复发性鼻咽癌71例切除及预后分析[J]. 中华耳鼻咽喉头颈外科杂志, 2015, 50 (11): 890- 895.
doi: 10.3760/cma.j.issn.1673-0860.2015.11.003
SUN Xicai , LIU Juan , WANG Huan , et al. Endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma: a review of 71 patients and analysis of the prognostic factors[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2015, 50 (11): 890- 895.
doi: 10.3760/cma.j.issn.1673-0860.2015.11.003
9 覃扬达, 司勇锋, 张政, 等. 鼻咽癌治疗后颈转移灶残留或复发的再治疗[J]. 中国耳鼻咽喉头颈外科, 2010, 17 (7): 337- 339.
doi: 10.16066/j.1672-7002.2010.07.022
QIN Yangda , SI Yongfeng , ZHANG Zheng , et al. Re-treatment of residual/recurrent cervical metastasis after radiotherapy for nasopharyngeal carcinoma[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2010, 17 (7): 337- 339.
doi: 10.16066/j.1672-7002.2010.07.022
10 Vlantis AC , Tsang RKY , Yu BKH , et al. Nasopharyngectomy and surgical margin status[J]. Arch Otolaryngol Head Neck Surg, 2007, 133 (12): 1296.
doi: 10.1001/archotol.133.12.1296
11 孙燕, 赵平. 临床肿瘤学进展[M]. 北京: 中国协和医科大学出版社, 2005: 1028- 1929.
12 Wei WI . Cancer of the nasopharynx: functional surgical salvage[J]. World J Surg, 2003, 27 (7): 844- 848.
doi: 10.1007/s00268-003-7110-9
13 King WW , Ku PK , Mok CO , et al. Nasopharyngectomy in the treatment of recurrent nasopharyngeal carcinoma: a twelve-year experience[J]. Head Neck, 2000, 22 (3): 215- 222.
doi: 10.1002/(ISSN)1097-0347
14 Hsu MM , Hong RL , Ting LL , et al. Factors affecting the overall survival after salvage surgery in patients with recurrent nasopharyngeal carcinoma at the primary site: experience with 60 cases[J]. Arch Otolaryngol Head Neck Surg, 2001, 127 (7): 798- 802.
15 张秋航. 内镜鼻窦外科技术的延伸与进步[J]. 中华耳鼻咽喉头颈外科杂志, 2009, 44 (7): 532- 534.
doi: 10.3760/cma.j.issn.1673-0860.2009.07.002
ZHANG Qiuhang . Development and extension of endoscopic endonasal surgical technique[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2009, 44 (7): 532- 534.
doi: 10.3760/cma.j.issn.1673-0860.2009.07.002
16 张秋航. 内镜颅底外科实践中存在的问题[J]. 中华耳鼻咽喉头颈外科杂志, 2018, 53 (4): 241- 243.
doi: 10.3760/cma.j.issn.1673-0860.2018.04.001
ZHANG Qiuhang . The practical problems on endoscopic skull base surgery[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2018, 53 (4): 241- 243.
doi: 10.3760/cma.j.issn.1673-0860.2018.04.001
17 Wang ZL , Zhang QH , Li MC , et al. The impact of resection of skull base tumor via an endoscopic endonasal approach on the visual function of vision impaired patients and the analysis of factors affecting their visual recovery[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2018, 53 (4): 244- 250.
doi: 10.3760/cma.j.issn.1673-0860.2018.04.002
18 Zhang QH , Wang ZL , Guo HC , et al. Endoscopic approach to remove intra-extracranial tumors in various skull base regions: 10-year experience of a single center[J]. Chin Med J, 2017, 130 (24): 2933- 2940.
doi: 10.4103/0366-6999.220306
19 张秋航, 孔锋, 郭宏川, 等. 内镜经鼻径路治疗侵犯斜坡硬膜内外沟通型脊索瘤[J]. 中华耳鼻咽喉头颈外科杂志, 2010, 45 (7): 542- 546.
doi: 10.3760/cma.j.issn.1673-0860.2010.07.004
ZHANG Qiuhang , KONG Feng , GUO Hongchuan , et al. Nasal endoscopic resection of extended intradural clival chordoma[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2010, 45 (7): 542- 546.
doi: 10.3760/cma.j.issn.1673-0860.2010.07.004
20 张秋航.内镜径路侧颅底肿瘤的外科治疗[C]. 2015年全国鼻科年会暨第七届鼻部感染与变态反应疾病专题学术会议.2015.
21 王卫东, 孙宏亮, 骆江红, 等. 覆膜支架腔内修复治疗颈动脉假性动脉瘤破裂出血[J]. 介入放射学杂志, 2017, 26 (1): 15- 19.
doi: 10.3969/j.issn.1008-794X.2017.01.004
WANG Weidong , SUN Hongliang , LUO Jianghong , et al. Endovascular repair with covered stent for the treatment of ruptured carotid artery pseudoaneurysms[J]. Journal of Interventional Radiology, 2017, 26 (1): 15- 19.
doi: 10.3969/j.issn.1008-794X.2017.01.004
22 李慎茂, 凌锋, 缪中荣, 等. 颈动脉狭窄血管内支架治疗并发症的临床分析[J]. 中国脑血管病杂志, 2005, 2 (2): 56- 61.
doi: 10.3969/j.issn.1672-5921.2005.02.003
LI Shenmao , LING Feng , MIAO Zhongrong , et al. Analysis of complications in percutaneous transluminal stenting for stenosis of internal carotid artery[J]. Chinese Journal of Cerebrovascular Diseases, 2005, 2 (2): 56- 61.
doi: 10.3969/j.issn.1672-5921.2005.02.003
23 聂本津, 缪中荣, 焦力群, 等. 颈动脉支架置入术后高灌注综合征与侧支循环的临床分析[J]. 中国脑血管病杂志, 2009, 6 (5): 263- 266.
doi: 10.3969/j.issn.1672-5921.2009.05.009
NIE Benjin , MIAO Zhongrong , JIAO Liqun , et al. Clinical study on relationship of hyperperfusion syndrome and coll-ateral circulation following carotid artery stenting[J]. Chinese Journal of Cerebrovascular Diseases, 2009, 6 (5): 263- 266.
doi: 10.3969/j.issn.1672-5921.2009.05.009
24 黎劭学, 陈锦华, 黄胜平. 球囊闭塞试验的适应证以及相关并发症的预防[J]. 中华耳鼻咽喉头颈外科杂志, 2011, 46 (4): 350- 352.
doi: 10.3760/cma.j.issn.1673-0860.2011.04.024
25 邱明国, 张绍祥, 刘正津, 等. 咽鼓管区薄层断层解剖学研究[J]. 解剖学杂志, 2002, 25 (1): 10- 14.
doi: 10.3969/j.issn.1001-1633.2002.01.003
26 Wen YH , Wen WP , Chen HX , et al. Endoscopic nasopharyngectomy for salvage in nasopharyngeal carcinoma: A novel anatomic orientation[J]. The Laryngoscope, 2010, 120 (7): 1298- 1302.
doi: 10.1002/lary.20958
27 Becker AM , Hwang PH . Endoscopic endonasal anatomy of the nasopharynx in a cadaver model[J]. Int Forum Allergy Rhinol, 2013, 3 (4): 319- 324.
doi: 10.1002/alr.21104
28 陈锐聪, 邹志敏, 蔡军, 等. 应用Hybrid手术室颅内外血管搭桥联合血管介人治疗颈内动脉受侵犯的鼻咽癌[J]. 广东医学, 2018, 39 (6): 960.
doi: 10.3969/j.issn.1001-9448.2018.06.039
[1] 卢朝阳, 翟兆雪, 王慧康, 邵丽婷, 张宇. 新冠肺炎治疗引发糖尿病酮症酸中毒合并鼻眶脑型毛霉菌病1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2026, 40(1): 90-94.
[2] 马馨,董凌康,吴红敏,易红良,邹建银. 外展悬吊缝合技术在阻塞性睡眠呼吸暂停治疗中的改良及应用进展[J]. 山东大学耳鼻喉眼学报, 2025, 39(3): 81-88.
[3] 马莉,高瞻,李鹏起,倪前伟. 鼻眶筛并发颧骨骨折伴发症解剖研究现状[J]. 山东大学耳鼻喉眼学报, 2024, 38(5): 126-130.
[4] 李浩,杨丽媛,张守凯. 鼻窦药物缓释支架在难治性鼻窦炎中的短期临床观察[J]. 山东大学耳鼻喉眼学报, 2024, 38(3): 38-42.
[5] 鲁欢,何本超,廖红明. 儿童急性鼻窦炎合并眶眼蜂窝织炎并发颅内感染1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2024, 38(1): 46-50.
[6] 岳涛,庄大勇,周鹏,李小磊,徐婧,朱见,贺青卿. 达芬奇机器人甲状腺手术中气管损伤并发症4例并文献复习[J]. 山东大学耳鼻喉眼学报, 2023, 37(3): 46-50.
[7] 柴丽娜,雷春燕,高昇,张美霞. 孤立先天性视网膜动静脉畸形合并玻璃体出血和内界膜下出血1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2023, 37(2): 67-70.
[8] 栾国刚,谌金金,严涛. 两种自制简易装置取出玻璃体硅油的方法[J]. 山东大学耳鼻喉眼学报, 2023, 37(1): 80-84.
[9] 董曙光,郭凤飞,孟旭霞,颜世龙. 早期开展飞秒激光辅助白内障超声乳化手术前囊膜撕裂原因的回顾性分析[J]. 山东大学耳鼻喉眼学报, 2023, 37(1): 110-114.
[10] 冯燚源,杨晶,杨洪斌. 220例颈深间隙感染临床分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(2): 51-57.
[11] 李莹. 重视角膜屈光手术操作规范及并发症防治[J]. 山东大学耳鼻喉眼学报, 2021, 35(6): 1-6.
[12] 次仁琼达, 吴元. 中毒性表皮坏死松解症导致眼部远期并发症1例[J]. 山东大学耳鼻喉眼学报, 2021, 35(6): 147-150.
[13] 赵雅铭,石崧. 以急性会厌炎为首诊的3例颈部坏死性筋膜炎病例报告并文献复习[J]. 山东大学耳鼻喉眼学报, 2021, 35(4): 12-16.
[14] 孙川,刘亚群,何双八,张庆翔. 低温等离子辅助经鼻切除前中颅底肿瘤17例[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 55-59.
[15] 魏佩佩,李灿. 多焦点人工晶体植入术后的视觉质量及并发症[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 141-146.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!