摘要
目的探讨不同头颈部恶性肿瘤治疗后大出血有效的急救方法。方法对18例成功抢救的不同头颈部恶性肿瘤手术和（或）放射治疗后大出血的病例进行回顾性分析。9例鼻咽部大出血病例中，1例大出血引起窒息进行紧急手术抢救，6例颌内动脉破裂行数字减影血管造影术（DSA）栓塞颌内动脉止血，2例鼻咽部溃疡者行溃疡切除，采用帽状腱膜鼻咽缺损修复止血。9例颈部大出血中，皆先行指压暂时止血，或立即在床旁用三角针、7号或10号丝线经皮行颈动脉破裂口上下结扎，再到手术室行规范的手术。结果1例由鼻咽癌放疗后引起的颅底颈内动脉破裂出血行颈总动脉结扎术；6例鼻咽大出血病例行CT和DSA检查证实颌内动脉破裂引起，行DSA介入栓塞颌内动脉止血成功；2例鼻咽部深部溃疡出血帽状腱膜修复缺损止血成功。3例鼻咽癌、3例喉癌和1例下咽癌颈动脉破裂口结扎止血后，颈部溃疡用胸大肌皮瓣修复6例，下斜方肌修复1例。6例肌皮瓣修复成功，1例喉癌修复颈部创面的胸大肌肌皮瓣部分坏死，颈动脉再次破裂出血后成功止血。1例甲状腺癌多次手术放疗后无法修复缺损创面；1例颈部淋巴瘤全身状况极差，未修复缺损创面。所有患者出血抢救后无偏瘫，1例鼻咽癌放疗后出血行颈总动脉结扎术后部分脑梗死，6个月后死于肺部感染；2例鼻咽癌出血抢救成功后在11个月后死于局部复发；其余病例在12～36个月内死于再复发（7例）、远处转移或（和）全身衰竭（8例）。结论针对不同头颈部恶性肿瘤治疗后大出血时的具体情况选择不同的治疗方法，DSA介入栓塞治疗和指压止血经皮颈动脉结扎分别是鼻咽癌放疗后鼻咽大出血和颈动脉破裂出血救治的有效方法。
Objective To discuss the effective emergency treatment to patients with different malignant tumors of head and neck after treatment. Methods Eighteen hemorrhage patients which have been successfully rescued with different malignant head and neck neoplasias after operation and （or） radiotherapy were analyzed retrospectively. Emergency treatment was used in 1 patient with nasopharyngeal cancer （NPC） suffering from massive epistaxis and suffocation after radiotherapy. The digital subtraction angiography （DSA） was used in 6 patients suffering from rupture of internal maxillary artery after irradiation for NPC. Two cases suffering from ulcer bleeding from deep par of pars nasalis pharyngis underwent repair of galea aponeurotica after elcotomy. Hemostasis by finger pressing and per- cutem ligation of carotid were used in 9 patients who suffered from rupture of carotid artery, then underwent normal treatment in operating room. Results Ligation of carotid artery was used in one patient with NPC after radiotherapy suffering from bleeding from arteria carotis interna of skull base. DSA was used in 6 patients with hemorrhage of nasopharynx who was confirmed rupture of internal maxillary artery by CT and DSA. Two cases suffering from ulcer bleeding from deep par of pars nasalis pharyngis underwent repair of galea aponeurotica; pectoralis major myocutaneous flap and infra-trapezius were used in 7 patients with laryngocarcinoma, carcinoma of iufra-pharynx, thyroid carcinoma and lymphadenoma of cervical part, 6 cases of them were successful while 1 patient＇s pectoralis major myocutaneous flap partly necrosis. One patient with thyroid carcinoma who can not be repaired after many operations and radiotherapies. One patient with lymphoma of cervical part also can not be repaired because bad body condition. All cases have no hemiplegic paralysis after first aid. One cases with NPC suffering from massive epistaxis that after ligation of carotid artery sufferred from partly cerebral infarction and died of pulmonary infection 6 months postoperatively; 2 cases of nasopharyngeal carcinoma died of recurrence 11 months postoperatively; other cases died of recurrence （7 cases）, metastasis and/or multiorganic failure of the whole body （8 cases） from 12 to 36 months. Conclusion Different treatments were used in different cases, The DSA and per cutem Ligation of artery after hemostasis by finger pressing were the modus operandi for NPC patients with intractable epistaxis after radiotherapy and patient sufferred from rupture of carotid artery respectively.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2008年第11期822-825,共4页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
关键词
头颈部肿瘤
出血
急救
Head and neck neoplasms
Hemorrhage
First aid
