Management and prevention of acute bleedings in the head and neck area with interventional radiology.
Management and prevention of acute bleedings in the head and neck area with interventional radiology.
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DOI：
10.1186/s13005-016-0103-3
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发表时间：
2016-01-23
影响因子：
3
通讯作者：
Bas M
中科院分区：
文献类型：
--
作者：
Storck K;Kreiser K;Hauber J;Buchberger AM;Staudenmaier R;Kreutzer K;Bas M
介入神经放射学在头颈部血管侵蚀和血管肿瘤所致急性出血的多学科治疗中变得越来越重要。作者报告了急诊情况下的急性颅外出血，以及术前良好血管化肿瘤的预防性栓塞及其结局。回顾性分析了52例患者，这些患者在德国慕尼黑工业大学Klinikum Rechts der Isar耳鼻喉科接受了ORL部门和介入神经放射学的跨学科方法超过5年半。根据栓塞成功率、失血量、生存率和治疗失败率分析其结局。39/52例患者接受了急性出血治疗。其中25例可归因于恶性肿瘤的血管侵蚀。受累血管为颈总动脉及其内外部分支，如咽升动脉、面动脉和上级甲状腺动脉。总共27/52名患者接受了恶性肿瘤治疗，25/52名患者是由于扁桃体切除术后鼻出血、良性肿瘤和炎症引起的出血所致。所有患者的治疗包括通过暴露、止血、电凝或外科结扎随后栓塞的不成功方法或通过介入栓塞/支架植入术的主要治疗。在ORL和介入神经放射学中对患者进行共同监测是一种重要的替代方法，特别是在恶性肿瘤或良性疾病血管侵蚀后严重急性出血的治疗中。但也必须考虑到良好的血管化肿瘤的术前栓塞，以防止严重失血或术中急性出血。
The Interventional Neuroradiology is becoming more important in the interdisciplinary treatment of acute haemorrhages due to vascular erosion and vascular tumors in the head and neck area. The authors report on acute extracranial haemorrhage in emergency situations but also on preventive embolization of good vascularized tumors preoperatively and their outcome. Retrospective analysis of 52 patients, who underwent an interdisciplinary approach of the ORL Department and the Interventional Neuroradiology over 5 ½ years at the Department of Otorhinolaryngology, Klinikum Rechts der Isar, Technical University of Munich, Germany. Their outcome was analysed in terms of success of the embolization, blood loss, survival rate and treatment failures. 39/52 patients were treated for acute haemorrhage. Twenty-five of them attributable to vascular erosion in case of malignant tumors. Affected vessels were the common carotid artery as well as its internal and external parts with branches like the ascending pharyngeal, the facial and the superior thyroid artery. Altogether 27/52 patients were treated for malignant tumors, 25/52 were attributable to acute haemorrhage due to epistaxis, after tonsillectomy, benign tumors and bleeding attributable to inflammations. Treatment of all patients consisted either of an unsuccessful approach via exposure, package of the bleeding, electrocoagulation or surgical ligature followed by embolization or the primary treatment via interventional embolization/stenting. The common monitoring of patients at the ORL and interventional neuroradiology is an important alternative especially in the treatment of severe acute haemorrhage, following vascular erosion in malignant tumors or benign diseases. But also the preoperative embolization of good vascularized tumors must be taken into account to prevent severe blood loss or acute intraoperative bleeding.