头面部外伤后迟发性鼻出血16例诊治分析

Clinical analysis of delayed epistaxis after craniofacial trauma in 16 patients

目的：探讨头面部外伤后迟发性鼻出血的病因、临床表现、诊断和治疗方案。方法：回顾性分析16例头面部外伤后迟发性鼻出血患者的诊治经过,患者均行DSA确诊,根据临床表现、影像学资料、随访资料,分析早期的诊断方法和最佳治疗方案。结果：14例患者为颈内动脉海绵窦段假性动脉瘤形成,出血量50-1 000ml,均行覆膜支架介入治疗;失明1例,出现视野缺损1例。另外2例患者为颌内动脉分支假性动脉瘤形成,伤后及伤后2周出血,出血量约200ml,行血管介入明胶海绵栓塞,术后无并发症发生。患者术后均无脑神经功能障碍并发症及再次鼻出血等发生,复查DSA未见假性动脉瘤复发。结论：头面部外伤后迟发性鼻出血主要由颈内动脉海绵窦段假性动脉瘤形成后破裂引起,颌内动脉动脉瘤也可引起迟发性鼻出血,CTA、MRA和DSA有助于早期确诊,血管介入治疗效果好。

Objective： To investigate the etiology, clinical presentations, diagnosis and treatment of delayed epistaxis after craniocerebral trauma. Method： A retrospective analysis was made including 16 cases who had the traumatic carotid artery injury with massive delayed epistaxis. All of them were finally diagnosed by digital substraction angiography（DSA）. Final clinical outcome, radiographic data and follow-up data were analyzed. Result： Two cases of traumatic pesudoaneurysm from internal maxillary artery were embolized with polyvinyl alcohol particles and gelatin sponge. Fourteen cases of traumatic pesudoaneurysm located in ICA cavernous segment was embolized by covered stent. The covered stent placement was successful in all 14 pseudoaneurysms. No procedure-related complications or deaths occurred during follow-up except one of the case with visual field defects and another case with vision loss. Conclusion：Patients with delayed massive epistaxis or recurrent epistaxis after craniofacial trauma which cause pesudoaneurysm should undergo CTA, MRA or DSA examination, and it is would help to get proper diagnosis and treatment as early as possible. No recurrence was found after successful endovascular techniques.