头面部外伤性假性动脉瘤致鼻出血的诊治

Diagnosis and management of epistaxis caused by traumatic pseudoaneurysm

目的探讨外伤性假性动脉瘤引起顽固性鼻出血的临床诊断思路。方法选择16例外伤后假性动脉瘤病例,男性12例,女性4例,年龄16～41岁,平均25.4岁,回顾性分析该组病例鼻出血的临床特点。结果该组病例1例死亡,其他患者行血管造影栓塞治疗后均痊愈出院。患者自入院到通过行数字减影血管造影(digital subtraction angiography,DSA)检查明确诊断为假性动脉瘤相隔时间最短为3天,最长为15天,平均为4.5天,患者均有多次行前后鼻孔填塞病史,填塞的次数最少1次,最多达5次,平均2.5次。结论外伤后反复大量鼻腔出血患者如行前后鼻孔填塞止血效果差,应尽早行DSA检查,明确有无假性动脉瘤存在,诊断明确后行血管造影栓塞治疗。尽可能避免盲目多次的前后鼻孔填塞给患者带来的痛苦,同时也可有效避免因延误诊断造成假性动脉瘤破裂致患者出血死亡的可能。

To study the diagnosis and management of epistaxis caused by traumatic pseudoaneurysm. METHODS The clinical data of 16 cases with epistaxis caused by traumatic pseudoaneurysm were retrospectively studied. There were 12 males and 4 females. Their ages ranged from 16 to 41 years with an average of 25.4 years. RESULTS All the patients were cured via digital subtraction angiogrophy （DSA） and embolization except one died. The time between the hospitalization and the DSA examinat ion was 3 to15 days. Interestingly, every patient had received anterior and posterior nasal packing one to 5 times. CONCLUSION If the anterior and posterior nasal packing were not effective to the patients with repeated and vast nasal bleeding, who had trauma history before nasal bleeding, the DSA examination should be carried out immediately to identify whether the pseudoaneurysm exists.