难治性鼻腔大出血的介入栓塞治疗

The interventional treatment of intractable epistaxis

目的 :探讨难治性鼻出血的选择性血管造影诊断和超选择性血管栓塞治疗。方法 :用Seldinger技术经股动脉穿刺 ,送入 5FCobra导管 ,入颈总动脉 ,行选择性血管造影 ,对出血血管进行分析、诊断 ,采用直径为 14 0～ 2 5 0um的真丝线段超选择性栓塞出血血管。结果 :全部病例止血效果确切 ,术后随访 2月～ 1年无复发 ,8例患者 1周内行耳鼻喉手术 ,均明显减少了术中出血 ,降低了手术难度 ,提高了手术成功率。结论 :本组资料表明 :选择性血管造影的诊断 ,超选择性的栓塞治疗 ,相应大小的栓塞物质和颗粒 ,适当的栓塞速度是成功的关键。上颌动脉栓塞治疗是一种安全、有效、简便的止血与治疗方法 ,并为耳鼻喉的部分手术开辟了良好的新途径。

Objective:To evaluate selective angiographic diagnosis and superselective embolization of intractable epistaxis in 21 cases.Methods:The seldinger technique was used in all patients. The catheter was introduced via femoral artery on the right side. Selective angiographic analysis and diagnosis were performed.Superselective angiographic embolization with silk thread in diamend form 140 to 250 um was performed in bleeding vessels.Results:All cases achieved satisfactory effect. During the follow-up 2 to 12 month, no patients recurrence nose bleeding. 8 cases were operated in 1 week. Bleeding reduced sharply in operation,and operative difficulty cut down and operative success rate was increased. Conclusion:Selective angiographic diagnosis,and Superselective angiographic embolization,and suitive size of silk thread granular,and appropriate embolic speed are critical for successful treatment of massive epistais,Maxillary artery embolization is safe,effective,and uncomplicated Interventional embolization has afforded a new methed for acoustic-nasola-larynxologic operation.