鼻内镜诊治顽固性鼻出血的临床分析-《中国微创外科杂志》

文章信息/Info

Title:: A clinical analysis of nasal endoscopic management for refractory epistaxis

Author(s):: Wang Li; ZhengHongcai; Zhou Yuying; et al.; Department ofOtorhinolaryngology, Peking UniversityThirdHospital, Beijing100083, China

摘要:: 目的总结鼻内镜诊治顽固性鼻出血的临床经验. 方法回顾性分析我院1998年1月～2004年12月258例顽固性鼻出血的临床资料,全部病例经鼻内镜探查鼻腔,行相应止血治疗. 结果鼻中隔出血118例,鼻腔侧壁出血47例,肿瘤出血8例,出血部位不明85例.258例中,有效257例(99.6%),死亡1例(0.4%),治疗过程中再出血43例,出血部位不明组再出血发生率明显高于出血部位明确组(χ2＝17.689,P=0.000). 结论鼻内镜下顽固性鼻出血的治疗重点应放在首次治疗,须仔细寻找出血部位,力争首次治疗成功;对反复出血病例应采取鼻内镜下前鼻填塞、鼻内镜下前后鼻栓塞、颌内动脉栓塞等综合治疗.

Abstract:: Objective　To summarize the clinicalexperience ofnasalendoscopic treatment for refractory epistaxis.　M ethods 　A retrospective analysis was made on 258 patients with refractory epistaxis treated with intranasal endoscopic exploration and hemostatic treatment from January 1998 toDecember2004 in this hospita.l　Results　Hemorrhagewas found on the nasal septum and the lateral nasalwall in 118 and 47 patients, respectively. Nose bleeding resulted from intranasal tumor in 8 patients. The site of bleeding was notclearly identified in 85 patients. Of the 258 patients, 257 responded to the treatment(99. 6% ) and 1 died (0. 4% ). Recurrentbleeding occurred in 43 patients. The incidence of recurrent bleeding was significantly higher in patients with unknown bleeding sites than in clearly diagnosed patients (χ2=17. 689,P=0. 000).　Conclusions　The emphasis of nasal endoscopic treatment for refractory epistaxis should be laid on the initialmanagement, duringwhich the bleeding site should be carefully identified. For patients with repeated nose bleeding, a combination treatment, including endoscopic filling-up of the anterior nasal cavity, endoscopic embolization of anterior and posterior nose, or embolization of the internalmaxillary artery, is necessary.