外伤性颌内动脉损伤引起严重鼻出血的诊断及治疗探讨(附12例报告)

目的 探讨颌面部外伤引起的颌内动脉损伤致严重鼻出血的发病机制、出血特点、诊断及治疗方法。 方法 回顾分析经手术或数字减影血管造影(DSA)证实颌面外伤引起的颌内动脉损伤致严重鼻出血12例的病例资料。 结果 6例行鼻内镜检查,见鼻腔外侧壁黏膜下有搏动出血,迅速改行柯-陆氏入路找到出血责任血管并止血,其中4例同期行上颌骨、颧骨骨折复位、钛板坚强内固定术。6例行DSA确诊并行血管栓塞治疗。 结论 对颌面外伤后反复鼻腔大出血患者,应考虑颌内动脉损伤,应尽早行鼻内镜检查止血和/或DSA检查并行栓塞治疗。若行鼻内镜检查止血过程中来不及栓塞治疗,可立即经柯-陆氏入路找到出血责任血管行血管结扎或电凝,也可填塞碘仿纱条止血。止血后请口腔颌面外科同期行颌面骨折复位坚强内固定术。

Severe nasal bleeding caused bytraumatic injury of the internal carotid artery:with a report of 12 cases

Objective To explore the the pathogenesis,characteristics,diagnosis and treatment of severe nasal bleeding caused by traumatic injury of the internal carotid artery.Method The clinical data of 12 cases were retrospectively an-alyzed.Result Of the 12 cases,6 cases underwent nasal endoscopy and were found beating bleeding at the submucosal lateral nasal wall,then were treated by the Caldwell Luc approach to stop bleeding,meanwhile 4 cases of them were treated by maxillary fracture and zygomatic fracture reduction and titanium plate internal fixation.Another 6 cases were made definite diagnosis with digital subtraction angiography (DSA)and were treated by parallel vascular embolization. Conclusion As for patients with maxillofacial injury with repeated nasal hemorrhage,they should be considered and treated by nasal endoscopy and/or DSA examination and embolization.If embolization is too late in the process of nasal endoscopy bleeding,ligation or electric coagulation could be performed out by the Caldwell Luc approach,also iodo-form gauze could be used for stuffing.After stopped bleeding,maxillofacial fracture reduction and internal fixation should be done.