鼻内镜下隐蔽部位鼻出血点的定位识别及处理

The Identification and Treatment of Nasal Endoscopic Concealed Nasal Petechial

目的:总结鼻内镜下定位识别隐蔽部位鼻出血点及微创止血的体会。方法:回顾分析本院76例隐蔽部位鼻出血患者内镜下诊治过程。结果:76例患者鼻出血点明确,其中鼻上部52例(68.4%):a.嗅裂中隔部42例(55.3%);②中鼻道中、后段6例(7.9%);③中鼻道前段4例(5.3%),鼻下部24例(31.6%):a.下鼻道后穹窿13例(17.1%);b.下鼻道外、下壁9例(11.8%);c.下鼻道前端2例(2.6%),双极电凝止血37例(48.7%)、射频止血28例(36.8%)、局部碘仿纱条定位填塞9例(11.8%),一次止血成功71例(93.4%)、两次止血成功5例(6.6%),电话随访1～2个月无复发。结论:在鼻内镜下以中鼻甲下缘为界将鼻腔分为上、下两部,采用分部按序逐步定位的方法,可以避免盲目操作,从而快速准确定位出血点,以达到微创、可靠的止血目的。

objective： to summarize the identification and treatment of Nasal Endoscopic Concealed Nasal Petechial. Method：analyzed retrospectively the treatment process of Nasal Endoscopic Concealed Nasal Petechial from April. 2004 to August. 2009. Result： 76 cases with clear Petechial, of which 52 cases with petechial on the upper part（68.4%）： ①42 cases with olfactory cleft of nasal septum（55.3%）;② 6 cases with posterior wall of middle nasal meatus（7.9%）;③4 cases with middle nasal meatus（5.3%）;lower nasal 24 cases（31.6%）：a. inferior meatus posterior fornix 13 cases（17.1%）;b.inferior meatus outer、inferior 9 cases（11.8%）;c.inferior meatus front end 2 cases（2.6%）,bipolar coagulation hemostasis 37 cases（48.7%）, radiofrequency hemostasis 28 cases（36.8%）, local iodoform gauze positioning packing 9 cases （11.8% ）,one -time hemostasis 71cases （93.4% , two-time hemostasis 5cases（6.6%）. No recurrence after 1～2 months telephone follow-up. Conclusion： Dividing nasal cavi- ty into upper and lower parts by middle turbinate under nasal endoscope, and gradual positioning can aviod blind operation and enable rapid and accurate petechia positioning, and achieve minimally invasive and reliable hemostasis.