复发性鼻咽癌内镜挽救手术中颈内动脉出血的处理

Management of internal carotid artery rupture during endoscopic salvage surgery for recurrent nasopharyngeal carcinoma

摘要:

目的 探讨复发性鼻咽癌鼻内镜挽救手术中的颈内动脉破裂出血的原因、应急处理措施。方法 回顾性分析青岛大学附属医院耳鼻咽喉头颈外科自2020年3月—2021年2月收治的2例复发性鼻咽癌患者术中发生颈内动脉破裂的临床资料，2例患者均采用电磁导航辅助鼻内镜入路行鼻咽恶性肿瘤切除术，发生颈内动脉破裂出血后，均以长碘仿纱条暂时压迫止血，紧急行颈内动脉血管内栓塞术，术后予以抗感染、抗凝及对症支持治疗。结果 治疗后2例患者围术期生命体征稳定，未出现近期及远期相关并发症。结论 比邻、侵犯或包绕颈内动脉的中晚期复发性鼻咽癌患者术前应充分评估颈内动脉状态及代偿情况，术中一旦出现颈内动脉破裂出血，应立即行碘仿纱条填塞压迫止血并紧急行介入治疗，可挽救患者生命、减少脑梗死等并发症的发生。

关键词:鼻咽肿瘤;自然腔道内镜手术;颈内动脉破裂;手术后并发症

Abstract:

Objective To investigate the causes, emergency management of internal carotid artery rupture and hemorrhage in endoscopic salvage surgery for recurrent nasopharyngeal carcinoma.Methods Clinical data of 2 patients with internal carotid artery rupture during the operation of recurrent nasopharyngeal carcinoma from March 2020 to February 2021 in the Department of Otorhinolaryngology Head and Neck Surgery, the Affiliated Hospital of Qingdao University were analyzed retrospectively. Both patients underwent electromagnetic navigation assisted endoscopic transnasal nasopharyngectomy. After rupture of internal carotid artery, the two patients were treated with iodoform gauze for hemostasis during operation, and emergency internal carotid artery embolization was performed. Postoperative anti-infection, anticoagulation and symptomatic supportive treatment were adopted.Results After treatment, the vital signs of both patients were stable during the perioperative period without associated complications.Conclusions In patients with intermediate or advanced recurrent nasopharyngeal carcinoma, if the tumor is adjacent to, invading or circumventing the internal carotid artery, the status and compensation of the internal carotid artery should be fully assessed before operation. Once internal carotid artery rupture and bleeding occur during surgery, iodoform gauze filling and compression hemostasis should be adopted immediately and emergency interventional therapy should be performed, which can save the patient’s life and reduce the occurrence of complications such as cerebral infarction.

Key words:Nasopharyngeal neoplasms;Natural orifice endoscopic surgery;Reputure of internal carotid artery;Postoperative complications