严重鼻衄行颌内动脉栓塞术并发脑梗塞死亡

报道１例严重鼻衄伴高血压、动脉硬化患者，经常规方法止血无效，行患侧颌内动脉超选择性栓塞术，术后鼻出血停止，但出现脑梗塞，昏迷，经救无效，于术后第９天死亡，认为对有动脉硬化的患者，应不用或慎用超选择性动脉栓塞术。     

鼻咽纤维血管瘤术前超选择性动脉栓塞的临床研究

目的探讨鼻咽纤维血管瘤术前超选择性动脉栓塞的临床价值。方法分析本院26例鼻咽纤维血管瘤病人的临床治疗资料。26例中术前行及未行超选择性动脉栓塞的各13例,比较两者术中平均出血量。结果术前行超选择性动脉栓塞者术中平均出血量为(790±167)ml、未行超选择性动脉栓塞术者术中平均出血量为(1184±225)ml,两者比较有统计学意义(P<0.05)。结论术前超选择性动脉栓塞可明显减少鼻咽纤维血管瘤术中的出血量。     

超选择性颈外动脉分支栓塞术在难治性鼻出血中的应用

目的:探讨经微导管超选择性颈外动脉分支栓塞术在治疗难治性鼻出血中的应用价值。方法:46例难治性鼻出血患者,首选超选择性颈外动脉分支栓塞术者36例,首选颈外动脉结扎者10例。结果:36例首选颈外动脉分支栓塞术者1次性治愈32例(88.9%),10例首选颈外动脉结扎者1次性治愈4例(40.0%)。前者平均住院4.8d,后者平均住院10d。复发患者均经综合方法有效止血,并发症少。结论:经微导管超选择性颈外动脉分支栓塞术治疗难治性鼻出血简便、安全、有效,疗效明显优于颈外动脉结扎,综合运用多种方法能有效治疗难治性鼻出血。     

颅底富血供肿瘤术前超选择性颈外动脉插管栓塞9例报告

目的：探讨超选择性颈外动脉插管栓塞术在颅底富血供肿瘤手术治疗中的作用。方法：对９例颅底富血供肿瘤患者术前先作双侧颈内、颈外及椎动脉造影后再行栓塞治疗。结果：９例栓塞后,肿瘤供血网显影消失,术中出血量明显减少,术后病理检查,镜下均见瘤体微血管及血窦内充满大量明胶海绵。结论：超选择性颈外动脉插管造影,在明确肿瘤血供类型后辅以术前栓塞治疗,既可缩小瘤体又能减少术中出血,是肿瘤围手术期处理的重要手段之一。     

鼻内镜下蝶腭动脉的电凝切断辅助超声刀切除鼻咽纤维血管瘤

摘要：目的探讨鼻内镜下蝶腭动脉的电凝切断辅助超声刀技术在鼻咽纤维血管瘤手术中的应用价值。方法回顾性分析2005年5月~2015年4月安徽医科大学第一附属医院耳鼻咽喉头颈外科收治的16例鼻咽纤维血管瘤患者的临床资料。均为青少年男性,所有患者手术前行数字减影血管造影(digital subtraction angiography, DSA）,其中9例行超选择性颈外动脉分支栓塞术,然后在内镜下切除肿瘤;另7例术前没有行选择性颈外动脉分支栓塞术患者直接行鼻内镜下电凝切断蝶腭动脉辅助超声刀技术切除肿瘤。比较两组手术时间、出血量、术后恢复时间、复发情况。结果两组手术时间、出血量、术后恢复时间比较,差异无统计学意义（P>0.05）;术后随访1～10年,两组患者均无复发。鼻内镜下蝶腭动脉的电凝切断辅助超声刀技术切除鼻咽纤维血管瘤避免了术前DSA的并发症及手术风险。结论鼻内镜下蝶腭动脉的电凝切断辅助超声刀技术是鼻咽纤维血管瘤切除一种安全、微创、有效的手术方法。术前是否选择行超选择性颈外动脉分支栓塞术要根据肿瘤的位置和分期以及术者的临床操作水平。     

超选择性血管栓塞后鼻内镜下微创手术治疗鼻咽纤维血管瘤I期的临床疗效

目的　探讨超选择性血管栓塞后鼻内镜下微创手术治疗鼻咽纤维血管瘤（nasopharyngeal angiofibroma,NA）I期的临床疗效。方法　48例NA患者分为栓塞组24例,非栓塞组24例,栓塞组24例均采用数字减影血管造影,再栓塞肿瘤供血动脉后行鼻内镜下微创手术切除肿瘤。结果  栓塞组术中出血量、手术时间比非栓塞组明显减少,两组差异有显著统计学意义（P＜0.05）。结论　NA术前超选择性血管栓塞可避免术中大失血,保证肿瘤完整切除,是一种安全、有效的方法。     

鼻咽血管纤维瘤手术治疗51例分析

目的比较鼻咽血管纤维瘤的治疗方法。分析各手术方式及术前超选择性动脉栓塞对不同分期患者治疗的优缺点。方法回顾性分析1989年2月—2004年10月51例鼻咽血管纤维瘤手术方式,采用Fisch分期,Ⅰ、Ⅱ期患者33例,经腭进路22例,鼻内镜手术11例;Ⅲ、Ⅳ期患者18例,经鼻侧切开9例,面中掀翻+LefortⅠ或同侧上颌骨拆装4例,颅面联合进路5例。51例患者中23例术前行超选择性瘤体供血动脉栓塞,其中Ⅳ期7例,Ⅲ期8例,Ⅱ期5例,Ⅰ期3例。结果术中平均出血量为1010ml,23例选择性瘤体供血血管栓塞患者,术中出血量200~870ml,平均485ml(x-±s,485ml±202ml);未栓塞组出血量500~3500ml平均1600ml(1600±757)ml,栓塞组平均出血量低于未栓塞组平均出血量(t=7·48,P<0·05)。术后1次复发8例,2次复发2例。术后复发时间平均为26·4个月(9~48个月)。结论术前行血管造影及血管栓塞对减少术中出血量具有临床意义。对于Ⅰ、Ⅱ期的患者,选择鼻内镜手术,可以避免传统手术创伤对患者术后颅面部生长发育的影响。对于Ⅲ、Ⅳ期患者,采用面中掀翻、LefortⅠ或同侧上颌骨拆装不仅有利于肿物的根治性切除,而且能够达到术后咬合关系影响小和美容佳的目的。     

鼻内镜下及鼻内镜引导下的鼻咽纤维血管瘤切除术

目的探讨经鼻腔鼻内镜下及鼻内镜引导下的鼻咽纤维血管瘤手术切除技术。方法回顾性分析11例经鼻内镜下及鼻内镜引导下的鼻咽纤维血管瘤切除术的临床资料。11例中,2例行术前颈外动脉结扎,2例术中行颈外动脉暂时性阻断术,7例行超选择动脉内栓塞术;9例患者行鼻内镜下经鼻腔肿瘤切除术,2例患者联合鼻内镜下及鼻内镜引导下经Caldwell-Luc切口进路切除肿瘤。结果Ⅰ、Ⅱ期患者中,4例术前行颈外动脉结扎术或术中颈外动脉暂时性阻断术,术中出血平均为250ml;5例术前行超选择动脉内栓塞术,术中出血平均为150ml。2例Ⅲ期患者术前行超选择动脉内栓塞术,术中出血为450ml。所有病例的肿瘤均为一期安全切除,随访6个月～4年无复发。结论鼻内镜下及鼻内镜引导下经柯-陆径路可完整切除位于鼻腔及鼻窦,甚至远至翼腭窝的鼻咽纤维血管瘤,并发症少,面部不留瘢痕。如若配合术前超选择动脉内栓塞术,术中出血量则明显减小。     

成人自发性难治性鼻出血的诊治分析CSCD

目的探讨成人自发性难治性鼻出血的临床特点、治疗方法及疗效。方法回顾分析2003年5月~2018年11月我院急诊收治住院的成人自发性难治性鼻出血患者共429例,经鼻腔填塞止血、鼻内镜下电凝止血、超选择性颈外动脉栓塞等多种治疗措施结合应用,取得良好效果。结果经单次单一治疗措施成功止血病例332例(77.4%),经2次及2次以上或结合2种及2种以上治疗措施后成功止血97例(22.6%)。其中经鼻腔填塞成功止血80例,经鼻内镜下电凝成功止血262例,经超选择性颈外动脉分支栓塞止血89例。结论鼻内镜下电凝止血仍是治疗鼻出血的首选方法,但超选择性动脉栓塞治疗难治性鼻出血止血迅速,效果肯定,复发率低,为难治性鼻出血的治愈提供了一种安全有效的方法。     

成人自发性难治性鼻出血的诊治分析

目的　探讨成人自发性难治性鼻出血的临床特点、治疗方法及疗效。方法　回顾分析2003年5月～2018年11月我院急诊收治住院的成人自发性难治性鼻出血患者共429例,经鼻腔填塞止血、鼻内镜下电凝止血、超选择性颈外动脉栓塞等多种治疗措施结合应用,取得良好效果。结果  经单次单一治疗措施成功止血病例332例（77.4%）,经2次及2次以上或结合2种及2种以上治疗措施后成功止血97例（22.6%）。其中经鼻腔填塞成功止血80例,经鼻内镜下电凝成功止血262例,经超选择性颈外动脉分支栓塞止血89例。结论　鼻内镜下电凝止血仍是治疗鼻出血的首选方法,但超选择性动脉栓塞治疗难治性鼻出血止血迅速,效果肯定,复发率低,为难治性鼻出血的治愈提供了一种安全有效的方法。     

数字减影血管造影在严重鼻衄中的应用

本文对我院1994年来,采用DSA血管栓塞治疗的13例严重鼻衄进行了分析。其中11例栓塞颌内动脉后止血;1例去除前、后鼻孔填塞物仍出血,再次栓塞面动脉后止血;仅1例插管失败。栓塞止血有效率为92．3％。无严重并发症发生。DSA具有实时显像、轨迹减影透视等功能。在严重鼻衄治疗中,有简单、有效、安全等优点。文章讨论了DSA的操作要点、并发症预防措施。认为DSA血管栓塞可作为治疗严重鼻衄常现方法。     

介入治疗鼻咽癌放疗后颈内动脉假性动脉瘤破裂大出血

目的探讨鼻咽癌放疗后颈内动脉假性动脉瘤破裂大出血的救治方法。方法3例鼻咽癌放疗后颈内动脉假性动脉瘤破裂大出血病人,采用数字减影血管造影术检查,明确颈内动脉假性动脉瘤破裂部位,在双侧大脑血管造影明确脑底Willis环交通通畅后,用球囊栓塞颈内动脉破裂处。结果3例均止血成功。1例术后1周后死亡;1例出院后3个月死亡,死因不明;另1例存活至今。结论对脑底Willis环交通通畅者,采用颈内动脉栓塞治疗鼻咽癌放疗后颈内动脉假性动脉瘤破裂大出血止血效果确切。但对于有放射性脑病的病人可能发生严重的并发症。     

Die perkutane Embolisationstherapie bei therapierefraktärer, nicht-traumatischer Epistaxis

The records of 24 patients with severe intractable non-traumatic epistaxis were reviewed to evaluate the efficacy of embolism therapy. MATERIAL AND METHOD: The histories of 17 patients with idiopathic epistaxis, 6 patients with Osler-Rendu-Weber disease and 1 patient with a high-flow angioma were analyzed. All patients were treated by means of percutaneous embolization of the maxillary artery and its branches. RESULTS: In 5/17 patients with idiopathic epistaxis repeat embolization was necessary in 5 cases, while permanent hemostasis was achieved in 16/17 patients with embolism alone. Five of the 6 patients with Osler-Rendu-Weber disease labelled stage III before treatment were managed successfully with repeated embolizations, while all cases were reduced to stage I disease. The high-flow angioma was successfully ablated after embolization combined with direct injection of thrombosing material and laser resection.     

创伤性迟发性鼻出血与假性动脉瘤关系的临床研究

目的 探讨创伤性迟发性鼻出血的诊断和治疗方法,并提出创伤性颌面部中小动脉假性动脉瘤性鼻出血的概念.方法 回顾性总结、分析了1990年3月-2005年3月期间山东省立医院耳鼻咽喉科收治的表现为创伤性迟发性鼻出血并接受数字减影血管造影检查和治疗的53例患者的有关资料.结果 该53例患者中,颈内动脉假性动脉瘤8例,其中7例行血管栓塞治疗,6例痊愈,1例死亡;另1例未行栓塞,在行建立侧支循环功能训练时出血死亡;颈内动脉海绵窦瘘20例,均使用可脱性球囊栓塞成功;颌面部中小动脉出血25例,21例为上颌动脉和或面动脉分支出血,使用明胶海绵颗粒结合弹簧圈行血管栓塞治疗,4例筛前动脉出血者行筛前动脉结扎术.随访6～72个月,中位随访时间为5年.除1例上颌动脉栓塞者再次鼻出血外,其余患者随访期间均未再出血,未发生严重并发症.结论 颈内动脉假性动脉瘤、颈内动脉海绵窦瘘、颌面部中小动脉假性动脉瘤性鼻出血是导致创伤性迟发性鼻出血主要原因,采用数字减影血管造影技术明确诊断并进行血管内栓塞或动脉结扎是治疗该类疾病的有效办法.     

Nontraumatic and postirradiated intracavernous carotid hemorrhage: an unusual case of epistaxis and review of the literature

Intracavernous carotid hemorrhage is a rare cause of epistaxis. We present a case of epistaxis caused by postradiotherapy and nontraumatic cavernous internal carotid artery (ICA) hemorrhage. An 80-year-old man was admitted to our hospital with a one week history of recurrent left-sided epistaxis and a past history of radiotherapy after radical maxillectomy. Emergent angiography revealed a leak in the cavernous segment of the ICA and subsequent detachable balloon occlusion embolization of the left internal carotid artery was performed without sequelae. We conclude that carotid artery hemorrhage must be considered in the differential diagnosis of profuse and recurrent epistaxis, especially for patients after craniofacial radiotherapy. ICA embolization is the definitive treatment provided cross circulation is adequate.     

Facial nerve paralysis following embolization for severe epistaxis (case report and review of the literature)

Embolization to treat intractable epistaxis is becoming increasingly popular. Twelve cases of facial nerve paralysis after embolization of branches of the external carotid artery have been reported. In this paper, a new case is reported. In epistaxis, embolization should be reserved for patients with contraindications to ligation or in emergency procedures.     

鼻咽癌放疗后大出血的诊治

目的探讨鼻咽癌放疗后大出血的诊治方法及治疗结果。方法收集2011年1月~2015年12月诊治的7例鼻咽癌放疗后大出血患者,分析其临床特点、各种诊治方法的特点及疗效。结果7例鼻咽癌放疗后大出血患者,治愈出院2例,转院行颈内动脉栓塞1例,已治愈。住院期间死亡3例,1例自动出院后死亡。结论鼻咽癌放疗后大出血积极的检查明确出血原因及部位,针对出血原因及部位可采取治疗措施,包括预防性气管切开,不得已情况下的长时间填塞及颈内动脉栓塞,能够有效降低鼻咽癌放疗后鼻出血的死亡率。     

Pseudoaneurysm of the internal carotid artery revelated by epistaxis: report of two cases

OBJECTIVES: Pseudoaneurysms of the carotid artery are a rare but serious cause of epistaxis. They can be rapidly life-threatening. Usually resulting of a surgery or a traumatism, pseudoaneurysms can express themselves by recurrent epistaxis. Management of these epistaxis is discussed. METHODS: The authors present two cases and effect a review of the literature. RESULTS: The first patient presented with a pseudoaneurysm few days after a transsphenoidal surgery. The second patient presented with a pseudoaneurysm fourteen years after a radio-surgical treatment of an ethmoidal and frontal epidermoid carcinoma. Diagnosis was suspected during nasal endoscopy and confirmed in both cases with angio-CT and arteriography. The first patient underwent a selective embolization. The second patient had to have a carotid occlusion due to a sudden severe haemorrhage, resulting from a pseudoaneurysm rupture following the embolization attempt. CONCLUSION: Review of the literature confirms the indication of endovascular intervention. The optimal management is carotid occlusion, provided the patient can tolerate carotid test occlusion and the circle of Willis is satisfactory. In some cases, a preservative treatment may be possible, which could be either pseudoaneurysm embolization or the placement of a covered stent.     

Treatment of severe epistaxis by superselective embolization: a review of 22 cases

OBJECTIVES: Epistaxis represents one of the most common ENT emergencies. In this paper, the authors report their experience in treating some cases of severe epistaxis by super-selective embolization of the afferent vessels of the nasal fossae. PATIENTS AND METHODS: A retrospective study of 22 patients with severe recurrent epistaxis (1 anterior and 21 posterior). All patients had been treated unsuccessfully with repeated anteroposterior nasal packing, and presented significant secondary anaemia. Selective embolization procedures were performed under local anaesthesia. An arterial introducer is inserted into the femoral artery -generally the right one- and diagnosis as well as treatment are performed with the same guide catheter. In all cases, the terminal branches of the facial artery and of the internal maxillary artery on the side on which the haemorrhage occurred were embolized. Moreover the contralateral internal maxillary artery was always embolized as well, in order to prevent immediate recurrence of hypervascularisation of the mucosa through anastomotic paths. RESULTS: In all patients, complete devascularisation was achieved in the areas of the embolized arteries at the nasal mucous membranes, arresting the epistaxis. None of the cases experienced complications attributable to treatment. DISCUSSION AND CONCLUSION: Superselective arteriography with embolization can be considered as the method of choice in treating severe epistaxis because it can be performed under local anaesthesia and can easily be repeated if the first procedure is not successful. Moreover, it is at least as effective as ligation of the internal maxillary artery, if not more so, but it has a significantly lower complication rate which is destined to fall as the quality of the materials being used continues to improve.     

外伤性颈内动脉海绵窦段损伤的诊断及血管内治疗

目的总结8例外伤性颈内动脉海绵窦段损伤的诊断及血管内治疗,并分析其发病机制。方法对8例头颅外伤史伴有眼部症状或鼻出血症状,考虑颈内动脉海绵窦段损伤的患者采用Seldinger技术股动脉插管造影诊断和介入栓塞治疗。结果数字减影血管造影（digtal subtraction angiography,DSA）成像诊断颈内动脉海绵窦瘘（carotid cavernous sinus fistula,CCF）6例,颈内动脉海绵窦段假性动脉瘤2例,均成功的行介入栓塞治疗,未出现明显的并发症,无1例患者死亡。结论对有头颅外伤史伴有眼部症状或鼻出血症状的应及早行DSA造影以明确诊断。介入栓塞技术为外伤性颈内动脉海绵窦段损伤的治疗中首选的方法。