鼻内镜下成人严重鼻出血处理

Management of adult obstinate epistaxis by endoscopy

目的:探寻成人严重鼻出血位置分布规律及有效微创处理方法。方法:通过鼻内镜观察成人严重鼻出血位置,并以微创手段进行止血。结果:129例成人严重鼻出血患者出血部位:鼻中隔嗅裂区及鼻顶前端68例(52.7%);下鼻道后端穹隆部37例(28.7%);蝶筛隐窝下方10例(7.8%);利特尔氏区8例(6.2%);中隔后上端5例(3.9%);部位不明1例(0.8%)。查明出血部位的128例患者为动脉出血,均予电凝止血。结论:绝大多数患者出血部位在鼻中隔嗅裂区、鼻顶前端和下鼻道后端穹隆部;鼻内镜下绝大多数出血部位均可发现;鼻内镜下电凝止血创伤微小,效果确切。

Objective： To explore the sites of adult obstinate epistaxis and investigate an effective and minimally invasive management for hemostasis under endoscopy. Method： Bleeding points were searched for and treated by electro-coagulation under an endoscope. Result： Bleeding was found in the olfactory cleft of the nasal septum and the top nasal septum in 68 cases （52.7%）, at the superior wall of the inferior meatus in 37cases （28.7%）, undemearth the sphenoethmoidal recess in 10 cases （7.8%）, in the Little＇s area in 8 cases （6.2%）, in the posterosuperior area of the nasal septum in 5 cases （3.9 % ） and was indefinite in 1 case. Conclusion： Almost all bleeding points of adult obstinate epistaxis cases can be found under endoscopy and they are mainly distributed in the olfactory cleft of the nasal septum and the top nasal septum, or at the superior wall of the inferior meatus. Electro-coagulation under endoscopy is an effective and minimally invasive management for adult obstinate epistaxis.