老年人隐蔽性鼻出血的鼻内镜诊治

Diagnosis and treatment under nasal endoscope for concealed epistaxis among aged persons

目的观察鼻内镜诊治老年人隐蔽性鼻出血的临床效果并评价其临床推广应用的可行性。方法经鼻内镜治疗的老年人隐蔽性鼻出血患者71例,回顾性分析其临床资料,总结诊治经过。结果本组病例中,依发生的频次高低,其出血部位依次为嗅裂(49例,69.01%)、下鼻道穹窿(10例,14.08%)、中鼻道后下区域(6例,8.45%)、鼻中隔前上区域(3例,4.23%)、鼻中隔骨性突起的凹面(3例,4.23%)。其中62例采用微波止血法,9例局部碘仿纱条加压填塞;1次性治愈62例(87.32%),2次治愈9例(12.68%)。随访3～5个月,鼻出血均无复发。结论老年人隐蔽性鼻出血好发于嗅裂水平的鼻中隔区域。于内镜下进行鼻甲骨折移位有利于明确出血点;对出血点采用微波凝固法或定位填塞,可有效制止鼻出血。

Objective To observe the therapeutic effects of diagnostic and therapeutic procedures under nasal endoscope on concealed epistaxis among aged persons based on a clinical trial and to evaluate the feasibility to promote this kind of therapeutic procedures for such conditions in clinical practice. Methods A retrospective study was carried out among 71 aged cases with epistaxis occurring in the concealed sites within nasal cavity and treated in our Hospital via carefully analyzing their clinical data, mainly those collected during the diagnostic and therapeutic course.Results In the order of frequency of bleeding occurred from high to low.the bleeding sites were at septum mucosa at olfactory cleft level（49 cases, 69.01%）, the formix of inferior meatus（10 cases, 14.08%）, posterior-inferior area in the middle meatus（6 cases, 8.45%）, anterior-superior area of the septum（3 cases, 423%）, and the concavity of deviated bone septum（3 cases, 4.23%）in this group of patients.Among these cases, 62 were treated by microwave coagulation and 9 were treated by pressured packing with iodoform gauze in the local area. Sixty-two （87.32%） of these cases were cured by only once treatment while 9（12.68%）cured by twice. A11 these cases were followed up for a period of 3 to 5 months, with no lesion reoccurred among them.Conclusions The commonly occurring location of epistaxis with a concealed site among aged persons is the area of septum mucosa at olfactory cleft level and the hemorrhagic spot in this area can be more definitely determined under nasal endoscope combined with middle and/or inferior turbinate 1aterally displaced. Microwave coagulation or pressured packing with iodoform gauze in the 1ocal area is capable of effectively stopping this kind of epistaxis.