- 期刊
利用覆蓋式血管支架治療頭頸部癌患頸動脈爆裂症候群
Endovascular Stent Graft for Carotid Blowout Syndrome in Patients with Head-and-Neck Cancers
摘要
頭頸部惡性腫瘤所引起的頸動脈破裂，發生率為百分之三至四。頸動脈假性動脈瘤治療可採手術切除和頸動脈重建結紮治；部份患者會因此產生嚴重中風。有些動脈瘤因體積巨大，位置較深，解剖結構複雜或病情嚴重伴有休克等情況下，手術風險太高或甚至無能為力。近年因血管內介入治療的發展，可經由導管在病變頸動脈內放置覆蓋式血管支架，達到止血以及保持頸動脈正常開放，防止腦中風。本研究屬於回溯型研究，研究期間為2012年1月1日到2012年12月31日，收案對象為曾經於2005/01/01到2011/12/31期間內在本院放射線診斷部針對頸動脈爆裂症候群執行覆蓋式血管內支架置放術病人，分析患者之CT/MRI與血管攝影之影像，並回顧病歷，分析短期及長期的預後以及是否有相關之併發症。其中併發症包含中風、腦出血、膿瘍、腦炎、腦膜炎或支架內形成血栓；預後是觀察患者是否有與支架放置相關問題，觀察患者的臨床症狀與存活時間。本研究收案個數共10位，平均年齡為50.0±12.5歲(範圍32-73歲)，均為男性。其中2位是口腔癌(20 %)，2位是鼻咽癌(20 %)，5位是下咽癌(50%)以及1位喉癌(10%)。臨床表現為以急性出血表現有2位(20%)，有8位(80%)以偽動脈瘤表現。病灶位置在內頸動脈處有4位(40%)，在總頸動脈處有1位(10 %)，有5位(50%)在頸動脈分岔處。併發症方面有一位在剛放完支架有腦梗塞中風現象，有一位放完支架5個月有支架阻塞，另外有一位放完支架9個月後發生腦膿瘍。因此本研究之結論為使用覆蓋式血管內支架可以達到有效止血的目的。
並列摘要
The risk of carotid artery rupture is 3-4% in head and neck cancer patients. Management of carotid pseudoaneurysm can be achieved by surgical resection and carotid reconstruction. However, the patients may suffer from stroke and pseudoaneurysm rupture. Recently, newly developed technique in endovascular intervention with covered stent being placed in internal carotid artery can achieve immediate hemostasis and keep patency of internal carotid artery. The advantage of endovascular intervention is small wound, short recovery period, less pain and less complication. We retrospectively analyzed medical charts, CT/MRI and angiographic images of patients who underwent covered stent placement in our institution during Jan 01, 2005 to Dec. 31, 2011. We assessed short term and long term prognosis and complication in these patients. Complications included acute ischemic stroke, brain hemorrhage, abscess, meningitis, and stent thrombosis/ occlusion. Total ten male patients were included in our study with average age 50.0±12.5years old (range 32-73 years old)。Among them, two had oral cancer (20 %), two had nasopharyngeal carcinoma (20 %), five had hypopharyngeal cancer and one had laryngeal cancer. The clinical symptoms were acute bleeding (20 %) and pseudoaneurysm (80 %). The location of bleedings were located in internal carotid artery(4/10，40 %), common carotid artery(1/10，10 %) and carotid bifurcation(5/10，50 %). The complication rate was 30 %. One had ischemic stroke soon after stent placement. One had stent occlusion 5 months after stent placement. One had brain abscess 9 months after placement. The results of the study demonstrated that covered stent can achieve effective hemostasis in patients with carotid blowout syndrome.