鼻咽癌放疗后并发颈动脉爆裂综合征1例
A Case of Carotid Blowout Syndrome following Radiotherapy for Nasopharyngeal Carcinoma
DOI: 10.12677/acm.2026.162360, PDF,   
作者: 李 禧, 涂 博*, 黄伽儒：暨南大学附属第一医院耳鼻咽喉头颈外科，广东 广州
关键词: 鼻咽癌；颈动脉爆裂综合征；放射治疗；出血；病例报告；Nasopharyngeal Carcinoma； Carotid Blowout Syndrome (CBS)； Radiotherapy； Hemorrhage； Case Report
摘要: 目的：探讨鼻咽癌放疗后并发颈动脉爆裂综合征的紧急处理措施，以提升临床救治水平。方法：报道1例鼻咽癌放疗后并发左侧颈内动脉破裂出血的病例，围绕机制、出血点定位、治疗术式选择、潜在风险评估等环节进行分析与讨论。结果：通过影像学检查成功定位出血点，并采用血管介入治疗有效控制出血。同时，多学科协作对于术中风险评估与并发症防治起到了关键作用。结论：鼻咽癌放疗后并发颈动脉爆裂综合征是危及生命的严重并发症，早期识别、精准止血及多学科综合处理是改善预后的关键。
Abstract: Objective: To explore emergency management strategies for carotid blowout syndrome (CBS) following radiotherapy for nasopharyngeal carcinoma (NPC) to enhance clinical treatment efficacy. Methods: A case of left internal carotid artery rupture and hemorrhage following radiotherapy for NPC was reported, focusing on analysis of mechanisms, bleeding site localization, treatment selection, and risk assessment. Results: Imaging identified the bleeding site, and endovascular intervention controlled the bleeding. Multidisciplinary collaboration was key in intraoperative risk assessment and complication prevention. Conclusion: CBS after NPC radiotherapy is life-threatening. Early detection, precise hemostasis, and multidisciplinary management are essential for better outcomes.
文章引用：李禧, 涂博, 黄伽儒. 鼻咽癌放疗后并发颈动脉爆裂综合征1例[J]. 临床医学进展, 2026, 16(2): 46-52. https://doi.org/10.12677/acm.2026.162360

参考文献

[1] 陈锐聪, 陈锦华, 白小欣, 等. 鼻咽癌放疗后鼻咽部大出血的血管内栓塞治疗[J]. 福建医科大学学报, 2018, 52(1): 57-59.
[2] Silverman, D.A., Parikh, A.S., Liu, K., Zhan, K.Y., Nimjee, S.M., Powers, C.J., et al. (2022) Predictors of Survival Following Carotid Blowout Syndrome. Oral Oncology, 125, Article ID: 105723. [Google Scholar] [CrossRef] [PubMed]
[3] Cohen, J. and Rad, I. (2004) Contemporary Management of Carotid Blowout. Current Opinion in Otolaryngology & Head and Neck Surgery, 12, 110-115. [Google Scholar] [CrossRef] [PubMed]
[4] Zheng, L., Yan, S., Yan, D., et al. (2013) Fatal Bleeding in a Nasopharyngeal Carcinoma Patient after Concurrent Chemoradiation plus Cetuximab: A Case Report. OncoTargets and Therapy, 6, 703-706. [Google Scholar] [CrossRef] [PubMed]
[5] Zhao, Z., Liao, Q., Yang, Y., Ma, Y., Lu, X., Qiu, Q., et al. (2023) Survival Analysis of a Comprehensive Treatment Strategy for Internal Carotid Artery Blowout Syndrome by Nasopharyngeal Carcinoma. Head & Neck, 45, 1875-1884. [Google Scholar] [CrossRef] [PubMed]
[6] 邱前辉, 肖旭平, 杨钦泰, 等. 鼻咽癌治疗后并发颈动脉爆裂综合征的临床处理专家共识[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 1-18.
[7] Peng, X., Wu, Y., Brouwer, U., van Vliet, T., Wang, B., Demaria, M., et al. (2020) Cellular Senescence Contributes to Radiation-Induced Hyposalivation by Affecting the Stem/Progenitor Cell Niche. Cell Death & Disease, 11, Article No. 854. [Google Scholar] [CrossRef] [PubMed]
[8] Kameni, L.E., Januszyk, M., Berry, C.E., Downer, M.A., Parker, J.B., Morgan, A.G., et al. (2023) A Review of Radiation-Induced Vascular Injury and Clinical Impact. Annals of Plastic Surgery, 92, 181-185. [Google Scholar] [CrossRef] [PubMed]
[9] Venkatesulu, B.P., Mahadevan, L.S., Aliru, M.L., Yang, X., Bodd, M.H., Singh, P.K., et al. (2018) Radiation-Induced Endothelial Vascular Injury: A Review of Possible Mechanisms. JACC: Basic to Translational Science, 3, 563-572. [Google Scholar] [CrossRef] [PubMed]
[10] 陈净华, 娄光明, 黄宇勇. 鼻咽癌放疗后大出血的诊治[J]. 中国耳鼻咽喉颅底外科杂志, 2017, 23(4): 359-362.
[11] 朱斌炜, 何翱, 王辰果. 头颈部动脉CTA检查在头颈部血管疾病中的诊断价值[J]. 心脑血管病防治, 2012, 12(2): 154-156.
[12] 丁海峰, 张孝文, 刘维荣, 等. 鼻窦内窥镜下探明鼻出血部位及其临床应用价值(附226例报告) [J]. 临床耳鼻咽喉科杂志, 2001(9): 409-410.
[13] Mok, J.S.W., Marshall, J.N., Chan, M. and van Hasselt, C.A. (1999) Percutaneous Embolization to Control Intractable Epistaxis in Nasopharyngeal Carcinoma. Head & Neck, 21, 211-216. [Google Scholar] [CrossRef] [PubMed]
[14] Lin, Z., Chen, J., Zou, X., Zhang, J. and Huang, D. (2025) Interventional Treatment Strategies for Carotid Blowout Syndrome after Radiotherapy for Nasopharyngeal Carcinoma. Cancer Management and Research, 17, 757-765. [Google Scholar] [CrossRef] [PubMed]
[15] Brinjikji, W. and Cloft, H.J. (2015) Outcomes of Endovascular Occlusion and Stenting in the Treatment of Carotid Blowout. Interventional Neuroradiology, 21, 543-547. [Google Scholar] [CrossRef] [PubMed]
[16] Zhou, J., Yang, K., Zhang, X., Liu, Z., Dmytriw, A.A., Xie, W., et al. (2025) A Systematic Review and Meta-Analysis of Endovascular Treatment of Carotid Blowout Syndrome. Journal of Clinical Neuroscience, 133, Article ID: 111024. [Google Scholar] [CrossRef] [PubMed]
[17] 张文静, 底瑞青, 叶琳, 等. 鼻咽癌放疗后鼻出血干预研究现状[J]. 护理研究, 2021, 35(1): 99-104.
[18] Ku, Y.K., Wong, Y.C., Fu, C.J., Tseng, H., Wang, L., Wang, C., et al. (2016) Timely Antecedent CT or MRI Can Help Predict Hemorrhage Site of Posttreatment Head and Neck Cancer, with Digital Subtraction Angiography Used as the Reference Standard. American Journal of Roentgenology, 206, 829-836. [Google Scholar] [CrossRef] [PubMed]
[19] Chaloupka, J.C., Putman, C.M., Citardi, M.J., et al. (1996) Endovascular Therapy for the Carotid Blowout Syndrome in Head and Neck Surgical Patients: Diagnostic and Managerial Considerations. American Journal of Neuroradiology, 17, 843-852.
[20] Chang, F.C., Lirng, J.F., Luo, C.B., Wang, S., Wu, H., Guo, W., et al. (2008) Patients with Head and Neck Cancers and Associated Postirradiated Carotid Blowout Syndrome: Endovascular Therapeutic Methods and Outcomes. Journal of Vascular Surgery, 47, 936-945. [Google Scholar] [CrossRef] [PubMed]
[21] Chang, F.C., Luo, C.B., Lirng, J.F., et al. (2013) Evaluation of the Outcomes of Endovascular Management for Patients with Head and Neck Cancers and Associated Carotid Blowout Syndrome of the External Carotid Artery. Clinical Radiology, 68, e561-e569. [Google Scholar] [CrossRef] [PubMed]
[22] Chen, C.T., Lin, Y.H., Chen, Y.F., Lee, C. and Lee, B. (2022) Air-Containing Necrosis as the Imaging Predictor for Imminent Carotid Blowout in Patients with Head and Neck Cancer. Journal of the Formosan Medical Association, 121, 1266-1272. [Google Scholar] [CrossRef] [PubMed]

为你推荐