外伤性颈动脉海绵窦瘘反复鼻衄的诊断和治疗

Diagnosis and treatment of the traumatic carotid-cavernous fistula with repeated massive epistaxis

目的 总结 8例外伤性颈动脉海绵窦瘘 (TCCF)反复迟发性大量鼻衄。方法 8例TCCF合并鼻衄患者入院前采用鼻腔填塞和颈动脉压迫止血。 8例中有 7例行急诊脑血管造影和血管内治疗 ,术中采用球囊闭塞TCCF的瘘口或闭塞颈内动脉的方法。结果 脑血管造影发现 8例中有 5例合并假性动脉瘤征象。 1例治疗前死亡 ,6例治愈 ,1例反复鼻衄者经三次血管内治疗不成功 ,通过内窥镜直接用肌肉填塞获得成功。结论 TCCF合并反复大量鼻衄的原因可能是TCCF同时合并颈内动脉与蝶窦相通形成的假性动脉瘤 ,或TCCF合并海绵窦前内侧壁破裂。此病症非常凶险 ,务求及时诊断和彻底治疗 。

Objective To review the diagnosis and treatment of traumatic carotidcavernous fistula(TCCF) with repeated delayed massive epistaxis.Methods All the eight patients with massive epistaxis received packing of posterior nasal cavity and compression of ipsilateral carotid carotid artery to stop the epistaxis before admitted. Seven cases were treated by endovascular methods in emergency. Occlusion of internal carotid artery or fistula of TCCF was used in operation.Results Cerebral angiogram showed that there were 5 cases of TCCF with signs of pseudoaneurysm. One case of massive aggressive epistaxis died before treatment. Six cases were cured. But in one case of TCCF with epistaxis the treatment failed after 3 endovascular procedure, and finally it was treated by directly packing cavernous sinus with muscle pieces by nasal endoscope.Conclusion The reasons of repeated delayed epistaxis may be pseudoaneurysm caused by communication between internal carotid artery and sphenoid sinus or rupture of anteriormedial wall of cavernous sinus. It requires prompt of diagnosis and thoroughness of treatment because of the precarious disease. Occlusion of ICA may be the first choice to the cases with pseudoaneurysm.