难治性鼻出血426例诊断与治疗

Diagnosis and treatment of intractable epistaxis in 426 cases

目的探讨难治性鼻出血患者的常见出血部位及治疗方法。方法表面麻醉下对426例鼻出血患者行鼻内镜检查，查找出血点，并进行微波治疗。结果420例查到出血部位，出血部位依次为：下鼻道穹窿顶部205例，嗅裂鼻中隔部108例，中鼻道后上部44例，中鼻甲下缘32例，利特尔氏区21例，鼻咽静脉丛10例。应用微波治疗治愈率为100％。结论年龄≥40岁的鼻出血患者，高血压动脉硬化是其主要病因，出血点呈微血管瘤或动脉破裂形式表现。内镜下查找鼻腔深部隐蔽部位出血点是成功治疗难治性鼻出血的关键。

Objective To investigate the common bleeding points and treatment method of in- tractable nosebleed patients. Methods Under the superficial anaesthesia, the bleeding points of 426 patients were searched by routine nasal endoscopy, and treated by microwave. Results The bleeding point was found in 420 cases, and the bleeding points were found in the following different sites： superior wall of inferior nasal meatus（205 cases） , olfactory cleft of nasal septum（ 108 cases） , posterosuperior wall of middle nasal meatums （44 cases） , underneath of middle nasal armor （ 32 cases） , Lyttle area （21 cases） , Woodruff＇ s plexus（10 cases）. The cure rate was 100% of microwave. Conclusions Hypertensive ar- teriosclerosis is the main cause of disease for the patients surpasses 40 years old. The bleeding points assumes the micro angioma or the artery burst. The key to successfully treat intractable epistaxis is searching nasal cavity depth portion hiding bleeding points by nasal endoscopy.