老年人顽固性鼻出血的处理

The treatment of the intractable aged epistaxis

目的 探讨老年人顽固性鼻出血的治疗方法及疗效。方法 回顾性分析 72例老年人顽固性鼻出血的治疗经过及资料。结果 72例中 ,5 0例与鼻中隔偏曲有关的患者施行了鼻中隔矫正术并取得良好止血效果。其中只有 2例因再次鼻出血复行血管栓塞术止血。有 10例无严重心血管疾病患者行数字减影造影及血管栓塞术成功止血。另有 12例在鼻内镜下检查及止血且效果良好。结论 与鼻中隔偏曲有关的老年人顽固性鼻出血患者应考虑施行鼻中隔粘骨膜下矫正术 ;数字减影造影及血管栓塞术是一种有效的治疗顽固性鼻出血的方法 ,但要严格掌握适应证 ;在鼻内镜下检查及止血 ,效果好且痛苦小 ,尤其适用于老年患者 ,值得推广应用。

Objective To evaluate the treatment and effectiveness of the intractabl episstaxis. Methods The data of 72 aged patients with intractable epistaxis were analysed retrospectively. Results Submeuous resection of nasal septum were performed on 50 patients suffered from epistaxis related to serious deviation of nasal septum and the effects were excellent. Two of them were retreated using digital subtraction agiography(DSA) and vascular embolization because of re-epistaxis. 10 patients with no serious cardiovascular diseases were cured after DSA and superselective endovascular empolization; another 12 of them were treated effectively with endoscopy due to poor conditions and showed good results with a little pain. Conclusion Submucous resection of nasal septurn should be used only for those patients with serious deviation in nasal septum. DSA and superselective endovascular embolization were effective means for intractable epistaxis, especialy in the elders but indication should be mastered strictly. The endoscopy was useful for the examination and worthy of expanding.