经耳内窥镜治疗难治性鼻出血的临床效果

Clinical effect of transaural endoscopy in the treatment of intractable epistaxis

目的探讨难治性鼻出血的常见出血部位、出血特点及耳内镜下的止血策略。方法经耳内窥镜治疗50例难治性鼻出血患者,分析、总结治疗效果。结果50例鼻出血患者出血点均在内镜下找到,其中下鼻道后穹窿处13例(26.0%)、嗅裂区35例(70.0%)、下鼻道前穹窿处2例(4.0%)。50例患者均止血成功,其中48例患者在耳内镜下射频治疗止血,2例嗅裂区出血患者合并有高血压,射频治疗后鼻腔仍有少量渗血,经心内科会诊调整降压药物,血压稳定后1 d,未再渗血。患者均达到理想的治愈效果,治愈率为100.0%。结论难治性鼻出血大多为动脉性出血,若处理不当,会造成不良后果,甚至危及生命;可应用耳内镜在鼻腔仔细寻找难治性鼻出血的出血部位,给予精准定位并有效止血。

Objective To explore the common bleeding location,bleeding characteristics and hemostasis strategy under ear endoscope of intractable epistaxis.Methods Fifty cases of intractable epistaxis patients were treated by ear endoscope,and the treatment effect was analyzed and summarized.Results The bleeding points of 50 patients with epistaxis were found under endoscopy,including 13 cases(26.0%)of posterior fornix of inferior nasal meatus,35 cases(70.0%)of olfactory fissure and 2 cases(4.0%)of anterior fornix of inferior nasal meatus.All the 50 patients were successful stanched.Among them,48 patients were treated with radiofrequency under ear endoscope for hemostasis;2 patients with olfactory cleft area bleeding complicated with hypertension still had a small amount of nasal bleeding after radiofrequency treatment,and the antihypertensive drugs were adjusted after cardiology consultation,then no blood leakage was found at 1 day after the blood pressure stabilized.All patients achieved the desired cure effect,with a cure rate of 100.0%.Conclusion Most of the intractable epistaxis is arterial hemorrhage.Improper clinical treatment can cause adverse consequences and even life-threatening.Ear endoscopy can be used to carefully find the bleeding site of intractable epistaxis in the nasal cavity,and give accurate positioning and effective hemostasis.