Bleeding is a rare but fatal complication after radiotherapy for nasoparyngeal carcinoma(NPC).In this article,we report an NPC case treated with radiotherapy complicated with bleeding of the common carotid artery(CCA).A 44-year-old man with NPC was treated with external radiotherapy 19 years ago,and a second course of treatment to the same field was administrated because of local nasoparyngeal recurrence 4 years ago.The patient was admitted to our hospital for massive bleeding.Conservative therapy including routine medication,blood transfusion and local compression showed almost no effect.Emergency carotid angiography revealed bleeding from the left CCA,and a self-expanding covered stent was deployed through percutaneous transluminal femoral approach.After the placement of the co-vered stent,angiography showed the bleeding was successfully controlled.So self-expanding covered stenting may be a safe,effective and minimal-invasive option for bleeding of the carotid artery.Long-term follow-up is required for further evaluation.Abstract:SUMM ARY B leed ing is a rare but fatal complication after rad iotherapy for nasoparyngeal carcinoma(NPC).In this article,we report an NPC case treated with rad iotherapy complicated with bleed ing of the common carotid artery(CCA).A 44-year-old man with NPC was treated with external rad iotherapy 19 years ago,and a second course of treatment to the same field was adm inistrated because of local nasopa-ryngeal recurrence 4 years ago.The patientwas adm itted to our hospital formassive bleed ing.Conserva-tive therapy includ ing routine med ication,blood transfusion and local compression showed almost no effect.Emergency carotid angiography revealed bleed ing from the leftCCA,and a self-expand ing covered stentwas deployed through percutaneous translum inal femoral approach.After the placement of the co-vered stent,angiography showed the bleed ing was successfully controlled.So self-expand ing covered stenting may be a safe,effective and m inimal-invasive option for bleed ing of the caro
目的:总结和对比去分支杂交手术和传统手术治疗胸腹主动脉瘤的近远期结果。方法:回顾性分析2008年1月至2019年12月采用传统手术治疗胸腹主动脉瘤的18例患者和采用杂交手术治疗的11例患者的临床资料。杂交手术组中,夹层动脉瘤、术前合并肾功能不全以及美国麻醉医师协会(American Society of Anesthesiologists,ASA)评分≥3分的患者比例明显高于传统手术组。结果:去分支杂交手术患者的手术时间为(445±85)min,术中出血量为(955±599)mL,术后30 d发生并发症2例,没有截瘫,死亡1例,术后30 d并发症发生率为18.2%,死亡率为9.1%。传统手术患者的手术时间为(560±245)min,术中出血量为(6100±4536)mL,术后30 d发生并发症12例,其中截瘫1例,死亡4例,术后30 d并发症发生率为66.7%,死亡率为22.2%。去分支杂交手术的术中出血量明显低于传统手术(P<0.001),30 d内并发症发生率显著降低(P=0.011)。随访期内,杂交手术组二次手术4例,死亡3例,1年、5年和10年的全因生存率分别为72%、54%和29%;传统手术组二次手术1例,死亡5例,1年、5年和10年的全因生存率分别为81%、71%和35%。杂交手术和传统手术在全因生存率和动脉瘤生存率上差异没有统计学意义。结论:去分支杂交手术是一种治疗高危胸腹主动脉瘤患者安全、有效的手术方式,术后早期并发症发生率明显低于传统手术,但中远期疗效仍需要进一步提高。
