表现为鼻出血的创伤性颈动脉损伤的治疗体会

Treatment and experience of traumatic carotid artery injury with massive epistaxis

回顾分析5例头面部外伤后鼻出血的创伤性颈动脉损伤患者临床资料,均经全脑血管造影检查明确诊断。2例颌内动脉分支损伤,以聚乙烯醇颗粒及明胶海绵栓塞;1例颈内动脉海绵窦瘘并蝶窦腔内假性动脉瘤形成,球囊闭塞瘘口和颈内动脉,再于后交通动脉近心端手术夹闭颈内动脉;1例颈内动脉自床突段闭塞,采用球囊闭塞颈内动脉主干;1例颈内动脉海绵窦末段假性动脉瘤,采用弹簧圈结合液态胶栓塞。术后无一例鼻出血复发。头面部外伤后鼻出血严重或反复鼻出血者,应行CT血管造影或全脑血管造影检查,及时明确诊断,尽早治疗。

A retrospective analysis was ma de on 5 cases who ha d the traumatic caroti d artery injury with massive epistaxis(from September 2007 to June 2011). All of them were finally diagnose d by digital substraction angiography(DSA). Among them, 2 cases of traumatic pesu doaneurysm from internal maxillary artery were embolize d with polyvinyl alcohol particles an d gelatin sponge. One case was caroti d cavernous fistula(CCF) with traumatic pesu doaneurysm locate d in the sphenoi d sinus. This patient's internal caroti d artery(ICA) an d fistula was blocke d with balloon, an d then ICA was clippe d proximal to the posterior communicating artery. One case with injurie d ICA was treate d with blocking by balloon. The pesu doaneurysm locate d in ICA cavernous segment of one case was embolize d with coil an d liqui d glue.No recurrence was foun d after successful surgeries. Patients with massive epistaxis or recurrent epistaxis after craniofacial trauma shoul d un dergo CT angiography(CTA) or DSA examination so as to get proper diagnosis an d treatment as early as possible.