下鼻道后穹窿鼻出血的临床特点及综合治疗

目的：总结下鼻道后穹窿鼻出血的临床特点并分析其综合治疗措施。方法：212例鼻出血住院患者中23例（10．8％）确诊为下鼻道后穹窿鼻出血，1例在全身麻醉下行鼻内镜鼻腔探查＋电凝止血术，其余22例在局部麻醉下行鼻腔探查＋电凝止血术。所有患者在术中排除了嗅裂、蝶筛隐窝及中鼻道出血，术中行下鼻甲骨折内移位后见下鼻道后穹窿活动性出血，立即给予双极电凝止血。术后电凝区域及鼻黏膜糜烂处填塞少量纳吸棉组织。结果：所有患者术中均发现明确的出血点并成功止血；术后1周内未再出血。随访6～12个月患侧鼻腔无再发鼻出血，无鼻腔粘连。结论：难治性鼻出血如排除嗅裂、蝶筛隐窝及中鼻道出血，则应考虑下鼻道后穹窿出血的可能。术中将下鼻甲往内侧骨折移位彻底暴露下鼻道后穹窿并仔细探查是发现和治疗下鼻道后穹窿鼻出血的关键。

The clinical features of epistaxis in the posterior fornix of inferior meatus and its comprehensive treatment measures

Objective：To summarize the clinical features of epistaxis in the posterior fornix of inferior meatus and its comprehensive treatment measures. Method： We collected and retrospectively analyzed the clinical data of 212 cases of epistaxis hospitalized in our department, among which 23 cases were diagnosed as epistaxis in the pos- terior fornix of inferior meatus. They underwent nasal endoscopic exploration and coagulation surgery with one case under general anesthesia and the other 22 under local anesthesia. The bleeding from olfactory cleft, spheno- ethmoidal recess and the middle nasal meatus were excluded for all the patients during the surgery. After shifting the inferior turbinate inward by fracture, the active bleeding was found in the posterior fornix of inferior meatus, which was stopped immediately by bipolar coagulation. The areas of coagulation and nasal mucosa erosion were packed with nasopore after operation. Result： For all the patients, bleeding spots were definitely located during the operation and successfully coagulated. None of them suffered from recurrent-bleeding within 1 week postoperative- ly. Followed up for 6 to 12 months, there was no epstaxis recurrence or nasal cavity adhesion at the bled side in all patients. Conclusion：For intractable epistaxis patient, after excluding the bleeding in olfactory cleft, sphenoeth- moidal recess and the middle nasal meatus, it should be considered that the bleeding might come from posterior fornix of inferior meatus. It is the key point to thoroughly expose the posterior fornix of inferior meatus by shifting the inferior turbinate inward by fracture and explore for the bleeding spot carefullv.