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[Management of intractable epistaxis and bleeding points localization of post-therapy nasopharyngeal carcinoma].

OBJECTIVE
To investigate the bleeding points and the management of post-therapy nasopharyngeal carcinoma intractable epistaxis.


METHODS
The bleeding points, treatment as well as its effects were studied retrospectively in 16 cases of post-therapy nasopharyngeal carcinoma intractable epistaxis. Among them 7 cases had been treated once, 9 cases recurred and received second treatment. Nasopharynx area had received radiotherapy from 70-160 Gy. Nasopharyngeal carcinoma intractable epistaxis occurred in 1-204 months (median time 13 months) after radiotherapy.


RESULTS
The bleeding points were found in the following different sites: internal carotid artery 8 patients, the internal maxillary artery of external carotid artery 7 patients, the arteriae pharyngea ascendens of external carotid artery 1 patient. All patients were tally by oronasal packing or intranasal balloons, 9 cases were carried out emergency tracheotomy. Post-therapy nasopharyngeal carcinoma intractable epistaxis was well controlled by transcatheter internal carotid artery balloon embolization in 1 case, transcatheter maxillary artery embolization in 6 cases, external carotid artery ligation in 1 case. Voluntarily stopping bleeding in 1 case. Seven cases among internal carotid artery 8 patients died, 1 case recovery. Seven patients of the internal maxillary artery of external carotid artery and 1 patient of the arteriae pharyngea ascendens of external carotid artery was recovery. There were no complications during a followed-up for 1-3 months after treatment.


CONCLUSIONS
After determined the points of post-therapy nasopharyngeal carcinoma epistaxis by angiography mainly the key factors in treatment of epistaxis of post-therapy nasopharyngeal carcinoma were vigorous applicated intractable endovascular treatment, nasal packing and tracheostomy. Internal carotid artery bleeding of post-therapy nasopharyngeal carcinoma still have the high mortality rate at present.