选择性动脉造影诊断和栓塞治疗严重鼻腔大出血

The selective angiographic diagnosis and endovascular embolization treatment of severe epistaxis

目的 评价选择性动脉造影和栓塞术诊断和治疗严重鼻腔大出血的临床价值。方法自发性出血 41例 ,外伤性出血 1 1例 ,鼻咽纤维血管瘤出血 3例 ,鼻咽部恶性肿瘤出血 2例。采用Seldinger技术 ,经股动脉插管造影诊断和栓塞治疗。选用明胶海绵条、手术用丝线或可脱性球囊及弹簧圈栓塞出血的动脉。结果 57例患者共行造影诊断和栓塞治疗 59次 ,6例做了双侧颌内动脉栓塞。 55例经导管栓塞治疗后迅即达到良好止血效果 ,术后随访 6个月至 2年均未再出血。本组病例中 ,7例颈内动脉海绵窦段损伤引起鼻腔大出血 ,用可脱性球囊和 (或 )弹簧圈栓塞治疗获成功。 4例面部外伤性鼻出血 ,2例单纯颌内动脉栓塞止血 ,另 2例经造影证实 ,由外伤所致眼动脉的筛支形成动脉瘤出血 ,经外科手术夹闭筛动脉后出血停止。结论 选择性动脉造影诊断和栓塞治疗严重鼻腔大出血 ,疗程短、痛苦小、成功率高、临床效果显著 。

Objective To evaluate selective angiographic diagnosis and embolization of severe epistaxis in 57 cases. Methods 41 cases with spontaneous haemorrhage,11 cases with traumatic haemorrhage, 3 cases with haemorrhage of nasopharyngeal fibroangioma, and 2 case with haemorrhage of nasopharyngeal carcinoma were included in the study. Selective angiographic diagnosis and embolization of epistaxis were performed with absorbable gelatin sponge or balloon or spring coil by using Seldinger′s method. Results 59 procedure of angiographic diagnosis and embolization were performed in 57 cases. Both maxillaris internal artery embolization was performed in 6 cases. After embolization, satisfactory results were achieved immediately in 55 cases After 6 months to 2 years′ follow up, no haemorrhage recurred.In 4 cases with traumatic haemorrhage in the face, simple maxillaris internal artery embolization was performed in 2 cases. Conclusion Selective angiographic diagnosis and embolization are safe, effective, and successful method of choices in the treatment of severe epistaxis.