放射治療後發生之顱外內頸動脈假性動脈瘤－病例報告

顱外內頸動脈的假性動脈瘤極為罕見，大部分因感染、外傷、及先前手術造成。因放射治療引起者，文獻上極為少見，本報告為一例55歲男性鼻咽癌患者，於放射治療後9個月發生右側內頸動脈假性動脈瘤出血。病人因大量鼻後方出血於1990年8月5日至本院急診，經緊急氣管切開及大量輸血暫時維持生命。病患接受鼻後方填塞及兩側外頸動脈結紮皆未能止血，動脈血管攝影顯示一假性動脈瘤，位於右側內頸動脈遠端近顱底處，但動脈栓塞亦告失敗。病人於8月6日接受右側總頸動脈結紮，並經開顱術夾住顱內內頸動脈。術後僅發生右側外展神經麻痺。已知的放射線動脈傷害有兩類：1)動脈狹窄。2)動脈破裂。假性動脈瘤可能繼發於放射治療後的動脈緩慢出血，但一旦破裂，可立即危及生命。本例因積極處置得宜，幸而保全生命。

關鍵字

假性動脈瘤；內頸動脈；放射治療

並列摘要

Pseudoaneurysms of the extracranial internal carotid artery are rare. Most cases are caused by infection, trauma, and previous surgery. Irradiation has rarely been reported as one of the causes. We report a man of 55 years of age who had a pseudoaneurysm of the right extracranial internal carotid artery 9 months after irradiation for nasopharyngeal carcinoma. He experienced massive posterior epistaxis despite of tracheostomy formaintaining airway at our Emergency Department on August 5, 1990. The epistaxis persisted despite posterior nasal packings and emergency ligation of bilateral external carotid arteries. Angiography then extablished the diagnosis but transarterial embolization also failed to stop the bleeding. On August 6, 1990, the patient underwent ligation of the right common carotid artery and clipping of the right internal carotid artery at the level above the anterior clinoid process via craniotomy. The epistaxis stopped. No neurologic deficit was encounterd postoperatively except right abducens palsy. The well-known arterial injuries due to irradiation are: 1)arterial rupture, occurring in weeks to months following irradiation; 2)arterial stenosis, in a few years after irradiation. The pseudoaneurysm is another sort of complication when an artery ruptures in a slower way and over a longer period. Angiography may help to achieve accurate diagnosis and early successful treatment.

並列關鍵字

pseudoaneurysm ； internal carotid artery ； irradiation

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放射治療後發生之顱外內頸動脈假性動脈瘤－病例報告

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