介入栓塞治疗难治性鼻出血的疗效分析

Therapeutic efficacy of transarterial embolization in treatment of intractable epistaxis

目的:研究介入栓塞治疗难治性鼻出血的造影表现及临床疗效。方法:回顾性分析2009年1月—2017年9月在我科接受介入治疗的59例难治性鼻出血患者的临床资料。59例患者按病因分为良性40例、恶性19例。按造影结果分阳性45例,阴性14例,根据病因与造影结果分类评价介入治疗难治性鼻出血的止血效果与复发情况。结果:所有59例患者均成功行血管造影术,其中58例成功进行介入栓塞止血,1例造影后因颈内动脉假性动脉瘤破裂出血死亡。良性患者的造影阳性率(29/40,72.5%)与恶性患者的造影阳性率(16/19,84.2%)差异无统计学意义(χ~2=0.436,P=0.509)。良性患者组的复发率(2/40,5.0%)与恶性患者组(4/18,22.2%)差异无统计学意义(P=0.068)。造影阳性组的复发率(4/44,9.1%)与造影阴性组的复发率(2/14,14.3%)差异无统计学意义(P=0.624)。结论:介入治疗难治性鼻出血安全有效;对于造影阴性的患者,经验性栓塞双侧上颌动脉远端分支能够有效止血。

Objective:To investigate the angiographic manifestation and evaluate the safety and efficacy of transarterial embolization(TAE)for intractable epistaxis.Methods:From January 2009 to September 2017,the clinical data of 59 patients with intractable bleeding undergoing TAE in our department were reviewed.All cases were divided into 40 cases of benign group and 19 cases of malignant group.According to angiographic findings,the patients were divided into 45 cases of positive group and 14 cases of negative group.The outcomes of interventional therapy were assessed according to different causes of disease(malignant or benign disease)and angiographic finding(positive or negative angiogram).Results:All the 59 patients recieved diagnostic angiography.Bleeding was controlled successfully in 58 patients after embolization except 1 patient who died of rupture of ICA pseudoaneurysm.Positive angiographic findings were found in 29 of 40 cases(72.5%)with benign diseases and 16 of 19 cases(84.2%)with malignant diseases,respectively,there was no significant difference between them(χ2=0.436,P=0.509).There was no significant difference in recurrence rates between patients with benign diseases(2/40,5.0%)and malignant diseases(4/18,22.2%)(P=0.068).No significant difference was found in recurrence rates between patients with positive(4/44,9.1%)and negative angiography(2/14,14.3%)(P=0.624).Conclusions:TAE appears to be a safe and effective treatment for patients with intractable epistaxis.For patients with negative angiographic finding,bilateral IMA embolization is an effective method.