损伤性鼻腔大出血的介入治疗

Interventional management of traumatic epistaxis

目的探讨经导管动脉栓塞术治疗损伤性鼻腔大出血的临床应用价值。方法回顾性分析15例外伤或手术后鼻出血患者,经药物及鼻腔填塞治疗失败后,采用经股动脉穿刺置入导管后先行颈外动脉造影明确出血点,再超选择插管至责任动脉以明胶海绵或聚乙烯醇(PVA)颗粒栓塞治疗。结果15例患者中9例为外伤后鼻出血,6例为鼻窦或副鼻窦手术后出血。14例用明胶海绵颗粒栓塞,1例用PVA颗粒栓塞,均1次栓塞成功,2～3d后成功去除填塞物,无严重并发症。结论经导管动脉栓塞术是控制保守治疗失败的鼻腔大出血的安全有效的方法,对于损伤性鼻腔大出血明胶海绵是首选的栓塞剂。

Objective To discuss the clinical application of transcatheter arterial embolization in the treatment of traumatic epistaxis. Methods Transeatheter arterial embolization was performed in 15 patients with traumatic epistaxis, caused by injury or snrgery, after they failed to respond to medication and nasal packing. Seldinger technique was adopted via the femoral access and the bleeding site was determined with carotid angiography, super-selective catheterization was then carried out to embolize the ruptured artery with gelfoam particles or polyvinyl alcohol （PVA） particles. The clinical data and the therapeutic results were analyzed. Results Of 15 patients, the epistaxis was caused by injury in 9 and by surgery of nasal or paranasal sinus in 6. Gelfoam particle was used in 14 cases and PVA particle in one case. The procedure was accomplished in one manipulation in all patients. The nasal tampon was removed in 2-3 days after the treatment with no recurrence of bleeding. No serious complications occurred. Conclusions Transcatheter arterial embolization is a safe and effective therapy for profuse epistaxis on which the conservative management exerts no effect, and the gelfoam particle is the embolization material of first choice.