鼻内窥镜手术后迟发性鼻出血15例临床分析

Delayed epistaxis after nasal endoscope operation:clinical analysis of 15 cases

目的了解鼻内窥镜手术后迟发性鼻出血的临床特征,探讨其治疗经验。方法回顾性分析2005年1月至2011年12月我院耳鼻咽喉科鼻内窥镜手术治疗鼻、鼻窦及相关疾病术后迟发性鼻出血15例患者的临床资料。结果本组15例鼻内窥镜术后迟发性鼻出血在手术后5～8天抽出鼻腔填塞物后发生,出血次数2～7次,出血量约70～1600毫升,中鼻道上颌窦开口后方出血6例,筛前动脉区2例,筛后动脉区2例,中鼻甲2例,蝶窦口下方蝶腭动脉3例。结论鼻内窥镜手术后一周左右,在抽取鼻腔填塞物后发生的迟发性鼻出血往往与术中损伤鼻腔相应部位血管有关,出血量大,多需要鼻内窥镜下电凝止血。

Objective To understand the clinical characteristics and discuss the treatment experience of delayed epistaxis after nasal endoscope operation. Methods A respective review was conducted in 15 cases that were diagnosed as delayed epistaxis after na- sal endoscope operation in the department of otolaryngology of this hospital from Jan. 2005 to Dec. 2011. Results Fifteen cases bled from the nose in five to eight days after nasal endoscopic surgery. The blood loss was about 70 to 1600 ml in 2 to 7 times of repeated epi- staxis. It was found that 6 cases had bleeding from posterior lateral nasal arteries branches in maxillary sinus ostium, 2 cases from anteri- or ethmoidal artery ,2 from posterior ethmoidal artery ,2 from middle turbinate, and 3 from sphenopalatine artery beneath sphenoid sinus. Conclusion Delayed epistaxis was often associated with intraoperative injury of nasal vessels and occurred around 7 days after nasal endoscope operation or the extraction of nasal packing material. Electrocoagulation for hemostasis under nasal endoscope is necessary.