难治性鼻出血的出血部位及治疗

Management of intractable epistaxis and bleeding points localization

目的探讨难治性鼻出血常见的出血部位及治疗方法.方法对92例常规鼻内镜检查未发现出血点,并经规范的鼻腔填塞未能控制的鼻出血患者的出血部位、与年龄的关系及疗效进行回顾性分析.结果出血部位依次为:下鼻道顶部56.5%(52 /92)、嗅裂鼻中隔部27.2%(25/92)、中鼻道后上部8.7%(8/92)及部位不明者 7.6%(7/92).出血部位与年龄有一定的相关关系,49岁以下年龄组以下鼻道顶部出血最为常见(67.3%,37/55), 50～59岁年龄组下鼻道顶部与嗅裂鼻中隔区出血分别为46.4%(13/28)及35.7%(10/28);而在60 岁以上则以嗅裂鼻中隔区出血比例最高(77.8% ,7/9).92例中,除8例嗅裂鼻中隔部出血行明胶海绵填塞及1例中鼻道出血因电凝止血失败而施行血管造影颌内动脉栓塞外,其余83例均采用电凝止血.全部病例1次治愈82例(89.1%),2次9例(9.8%),4次1例(1.1%),随访1～3个月无复发.结论鼻内镜技术结合中、下鼻甲骨折移位对探查鼻腔深部的出血点具有重要意义,对出血部位进行准确电凝或填塞,是止血成功的关键.

Objective To investigate the common nasal bleeding points and the management of intractable epistaxis. Methods The bleeding points and its correlation with age distribution, surgical techniques as well as its effects were studied retrospectively in 92 patients, in whom the bleeding points were not found by routine nasal endoscopy and the hemorrhage was not controlled with standard nasal packing. Results The bleeding points were found in the following different sites: superior wall of inferior nasal meatus (56.5%, 52/92), olfactory cleft of nasal septum (27.2%, 25/92), posterosuperior wall of middle nasal meatus (8.7%, 8/92) and uncertain (7.6%, 7/92) . The results showed that the bleeding points had correlation with age. Epistaxis was well controlled by electrocoagulation in 83 cases,gelfoam packing in 8 cases,and transcatheter maxillary artery embolization in 1 case. There were no complications during a followed-up for 1-3 months after management. Among the 92 cases, the numbers of treatment needed to stop bleeding were 82 cases(89.1%) after 1 time of treatment, 9 cases(9.8%) after 2 times and in one case(1.1%) after 4 times. Conclusions Endoscopy combined with displacement of the middle and inferior turbinate gives good visualization and direct management of the deeply-sited bleeding points, which were difficult in localization. The combined method provides an effective and safe way to control intractable epistaxis.