难治性或复发性鼻出血的评估和治疗

Evaluation and treatment for the intractable or recurrent epistaxis

目的总结鼻内镜治疗难治性或复发性鼻出血的经验。方法回顾性分析2011年至2016年该院收治的39例患者的临床资料,所有患者均符合难治性或复发性鼻出血的诊断。依据是否发现出血点和鼻腔狭窄情况分为1组(有出血点,21例)、2组(未发现明显出血点,15例)和3组(有鼻中隔偏曲及鼻腔狭窄,3例)。记录患者疾病特征及就诊时状况。鼻内镜清理鼻腔,查找出血点,且进一步进行针对性治疗。结果1组患者中电凝治疗14例,填塞可吸收明胶海绵3例,填塞膨胀海绵4例。2组患者中观察8例,采用可吸收明胶海绵填塞7例。3组患者均采用鼻中隔偏曲矫正手术。再次出血者查找出血点对进行对应治疗。电凝、膨胀海绵和可吸收明胶海绵的再出血率分别为14.3%(2/14)、27.8%(1/6)、40.0%(4/10)。随访3个月无明显再次出血,10例患者存在鼻腔粘连。结论鼻内镜电凝止血是治疗难治性或复发性鼻出血的首选方法。

Objective To report the experience of treating intractable or recurrent epistaxis under nasal endoscope in our center. Methods The data of 39 patients from 2011 to 2016 with intractable or recurrent epistaxis were collected.The nasal cavity was cleaned under nasal endoscope and the bleeding sites were carefully checked.Further examinations and different treatments were applied. Results Patients were divided into 3 groups based on the presence of bleeding site and nasal septum deviation:(1)Twenty-one patients presented causal bleeding sites.The treatment included electro-cauterization in 14 patients,fragmentable nasal dressing placement in 3 patients,and nasal tampon foam packing in 4 patients.Rebleeding occurred in 5 patients,only 2 patients were from the cauterization treated panel,further cauterization or packing were performed.(2)Fifteen patients presented no specific bleeding site,8 patients were kept observation only and the remaining 7 patients had fragmentable dressing placed.Bleeding sites were found when there′s rebleeding in 5 patients,and electro-cauterization was applied.(3)Three patients presented significant nasal septum abnormality and septoplasty was performed,the bleeding site was found in 2 patients.The recurrent rate after electric cauterization,nasal tampon foam and fragmentable dressing were 14.3%(2/14),27.8%(1/6) and 40.0%(4/10) respectively.After 3 months of follow up,there were no severe complications except the synechia in 10 patients. Conclusion Endoscopic electric cauterization is the excellent modality for the intractable or recurrent epistaxis.