鼻内镜下治疗鼻腔后端鼻出血46tN疗效观察

Effecfs of endoscopic surgical in treatment of posterior epistaxis and bleeding points localization

目的探讨鼻内镜下治疗鼻腔后端出血的方法及体会。方法对武警总医院46例常规鼻内镜检查发现鼻腔后端出血，并经规范的鼻腔填塞未能控制的鼻出血患者的出血部位及疗效进行回顾性分析。结果出血部位依次为：下鼻道穹窿部50％、嗅裂鼻中隔部32．6％、中鼻道后上部4．3％及部位不明确者6例（13．1％）。46例中，除6例鼻出血部位弥散因电凝止血失败而施行鼻内镜蝶腭动脉结扎外，其余40例均采用电凝止血。40例电凝止血者1次治愈34例（85．0％），2次治愈6例（15．0％），随访1个月无复发。结论鼻内镜技术对探查鼻腔后端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。鼻内镜下蝶腭动脉结扎亦是治疗鼻腔后端出血的有效方法。

Objective To investigate the effects of endoscopic surgical management on posterior epistaxis and bleeding point localization. Methods The clinical data of 46 patients with posterior epistaxis （all single side）, 30 males and 16 females, aged 43.9, which failed to respond to standard nasal packing with their bleeding points not found and then underwent endoscopic surgical management, were analyzed. The patients were followed up for 1 month. Results The bleeding points of 40 of the 46 patients were found to be at the following sites respectively： superior wall of inferior nasal meatus （50%）, olfactory cleft of nasal septum （32. 6% ）, and posterosuperior wall of middle nasal meatus （4.3%）, and those of 6 cases remained uncertain（13.1%）. Epistaxis was well controlled by electrocoagulation in 40 cases, and by transnasal endoscopic sphenopalatine artery ligation in 6 cases. No complication was found during the follow-up. The bleeding was stopped after only one operation of electrocoagulation among 34 of the 46 patients （85%）, and 6 cases （15%） needed eleetroeoagulation for 2 times. Conclusion Endoscopy gives good visualization and direct management of posterior epistaxis. Transnasal endoscopic sphenopalatine artery ligation provides an effective and safe way to control intractable epistaxis.