两种不同术式治疗难治性鼻出血疗效比较

Comparison of two different surgical procedures in treatment of refractory epistaxis

目的比较鼻内镜下出血灶电凝术和鼻内镜下蝶腭动脉电凝术治疗难治性鼻出血的近、远期疗效。方法对2006年1月至2009年1月82例难治性鼻出血临床资料进行分析，内镜下出血灶电凝组（直接止血组）68例。内镜下蝶腭动脉电凝组（间接止血组）21例。所有病例随访12～48个月，治疗后第3个月末，记录患者的止血情况，随访期间最末次复查记录患者的复发情况。比较两组的止血成功率和术后鼻出血复发率。结果直接止血组、间接止血组止血成功率分别为89.7％和90．5％，差异无统计学意义（X^2=0．10，P=0．918）。两组的术后复发率分别为27．9％、4．8％。差异有统计学意义（X^2-4．644，P=0．033）。结论鼻内镜下蝶腭动脉电凝术与内镜下出血灶电凝术相比较，近期疗效相当。远期疗效更佳，复发率低，为鼻内镜下不能明确出血灶或电凝术失败的鼻出血患者的治疗提供另一种选择。

Objective To compare short-term, long-term therapeutic effect of endoscopic electric coagulation with endoscopic ligation of sphenopalatine artery in management of refractory epistaxis. Methods Eighty nine cases of refractory epistaxis admitted from January 2006 to January 2009 were included in the study. Sixty eight patients received endoscopic electric coagulation （direct hemostasis group） and 21 patients underwent endoscopic ligation of sphenopalatine artery （indirect hemostasis group）. All patients were followed-up for 12 -48 months, the arresting bleeding was recorded in the end of 3rd month after treatment, and the recurrence of postoperative epistaxis was recorded in end of follow-up. The successful rate in arresting bleeding, the recurrent rate of postoperative epistaxis were compared between two groups. Results There was no significant difference between direct hemostasis group and indirect hemostasis group in the successful rate of arresting bleeding （89.7% vs 90.5%, X^2= 0.10, P = 0.918）. After follow-up for 〉 6 months, there was significant difference between two groups in the recurrence rate of postoperative epistaxis （27.9% vs 4.8%, X^2= 4.644,P = 0.033）. Conclusion Endoscopic ligation of sphenopalatine artery is as effective as endoscopic electric coagulation in arresting bleeding, but it has lower recurrence rate of postoperative epistaxis and no severe complications in treatment for refractory epistaxis.