鼻咽癌放疗后大出血的相关因素分析及治疗方法*

摘要

Objective:To explore the clinical measurements for preventing and curing epistaxis in patients irradiated for nasopharyngeal carcinoma by analyzing the related factors. Methods:Thirty patients irradiated for nasopharyngeal carcinoma and consequently presented epistaxis were retrospectively reviewed by analyzing the clinical characteristics and measurements. Literature review was also performed. Results:Twenty-two cases were successfully rescued, and eight cases died (mortality rate:26.6%). Twenty-five cases underwent inflation sponge packing hemostasis, whereas three cases underwent endoscopic hemostasis with cauterization. Five patients underwent digital subtraction angiography (DSA) and selective arterial embolization. For patients who underwent one irradiation course, the epistaxis latent period ranged from 3 to 12 years, and the amount of bleeding ranged from 200 mL to 1 200 mL. For patients who underwent more than one irradiation course, the epistaxis latent period ranged from 6 months to 3 years, and the amount of bleeding ranged from 300 mL to 8 000 mL. Conclusion:Packing through choanal atresia by using inflation sponge, cautery under endoscopy, DSA, and selective arterial embolization are useful and effective measurements for hemostasis. The epistaxis latent period and volume are related to the age, tumor stage, and ir-radiation course of the patients. Patients with advanced age, tumor stage, and more than one irradiation course have short latent period and high amount of bleeding.%目的：分析鼻咽癌放疗后大出血的相关危险因素，探讨鼻咽癌放疗后出血的临床预防及诊治措施。方法：回顾分析中山大学孙逸仙纪念医院2007年1月至2012年6月诊治的鼻咽癌放疗后出现大出血患者30例的临床特点、治疗方式并结合文献进行总结。结果：25例患者行膨胀海绵填塞止血，3例患者在鼻内镜下行射频烧灼止血，5例患者行动脉插管血管造影选择性动脉栓塞术（DSA）止血。22例抢救成功，死亡8例（死亡率26.6%）。单程放疗发生大出血的潜伏期为3～12年，出血量为200～1200 mL；再程放疗潜伏期为6个月至3年，出血量为300～8000 mL。结论：后鼻腔填塞止血、鼻内镜下烧灼止血及选择性动脉栓塞是目前可行有效的止血措施，发生大出血的潜伏期及出血量与患者的年龄、肿瘤分期和是否为再程放疗有关；其中高龄、肿瘤分期晚和再程放疗的患者出血潜伏期短，出血量大。