鼻咽部纤维血管瘤栓塞治疗的护理

目的探讨鼻咽部纤维血管瘤栓塞治疗的临床价值以及临床护理。方法14例经手术病理证实的鼻咽部纤维血管瘤患者,术前全部行双侧颈内外动脉及椎动脉血管造影。肿瘤颈外系统供血动脉术前使用明胶海绵或PVA颗粒栓塞治疗,栓塞后1～3d行手术切除。结果14例患者由颈内外动脉不同分支供血,栓塞后手术全切率为92．9％（13／14）。配合综合护理,所有患者栓塞后均未发生严重并发症。结论术前血管内栓塞鼻咽部纤维血管瘤能减少术中出血量,缩短手术时间,是一种安全而有效的辅助治疗方法,术后护理对于保证手术成功有重要作用。     

经导管超选择栓塞术在耳鼻喉疾病中的临床价值研究

目的评价经导管超选择栓塞术在耳鼻喉疾病中的临床应用价值。方法2005年11月至2009年1月间,14例患有耳鼻喉疾病的患者应用超选择血管栓塞术诊治,男13例,女1例。年龄13～79岁,单纯严重鼻出血4例,鼻咽癌及上颌窦癌致顽固出血各2例,扁桃腺手术术后出血1例,鼻咽纤维血管瘤术前栓塞5例。结果9例严重鼻出血中经超选择血管栓塞治疗后,出血均获得有效的控制,5例鼻咽纤维血管瘤术前栓塞肿瘤供血动脉均获成功,减少了术中出血量,手术野清晰,实体瘤更易于辨认、切除。所有行超选择血管栓塞术的患者均未发生严重并发症。结论超选择血管栓塞术是诊断和治疗严重耳鼻喉出血的安全、有效的方法。鼻咽纤维血管瘤术前行超选择血管栓塞,能有效地减少术中出血量,有利于提高手术的成功率,减少并发症。     

鼻咽部纤维血管瘤血管造影诊断和栓塞治疗的临床研究

目的探讨血管造影诊断和血管栓塞治疗鼻咽部纤维血管瘤的安全性和有效性。方法采用股动脉经路，对32例鼻咽部纤维血管瘤患者进行双侧颈内外动脉造影；并采取超选择插管对鼻咽部纤维血管瘤的供血血管进行栓塞。结果32例经造影诊断明确，且供血血管显示清楚的患者进行了超选择性动脉血管栓塞。栓塞疗法止血效果肯定，术后血管瘤体积明显缩小，术中出血少。结论血管造影和血管栓塞治疗鼻咽部血管瘤是一种安全有效的方法。     

鼻咽纤维血管瘤术前动脉栓塞的临床应用

目的:探讨鼻咽纤维血管瘤术前栓塞的临床价值.材料与方法:回顾性分析56例鼻咽纤维血管瘤患者临床资料.其中39例(51次手术)术前均行双侧颈内、外动脉及椎动脉造影,明确肿瘤血供后,用明胶海绵微粒栓塞颈外动脉供养血管网,在此基础上再以1 mm×1 mm×10 mm明胶海绵条或弹簧圈栓塞供血动脉主干,栓塞后1～3天手术切除肿瘤(栓塞组);17例(28次手术)直接行手术切除肿瘤(未栓塞组).结果:栓塞组术前血管造影中见到丰富的肿瘤血管网、肿瘤染色.栓塞后造影复查,所有被栓塞血管供养区域肿瘤血管网及肿瘤染色消失、供血动脉主干闭塞,无严重并发症.栓塞组有术中出血量记录者37例,出血量50～6000mL,平均(1 636.22±1 529.79) mL;未栓塞组有术中出血量记录者12例,出血量500～3 900 mL,平均(2816.67±1 154.31) mL,两组差异有显著统计学意义(P＜0.05).结论:鼻咽纤维血管瘤术前栓塞能减少术中出血,增加手术的安全性,是理想的术前辅助治疗手段.     

12例鼻咽纤维血管瘤的术前栓塞治疗临床分析

目的对鼻咽纤维血管瘤术前栓塞的疗效及并发症进行评价。方法回顾性分析2002年11月至2006年11月以来经手术及病理证实的鼻咽纤维血管瘤患者12例,12例鼻咽纤维血管瘤手术前1～3d行超选择供血动脉栓塞,详细观察栓塞后毒副作用及并发症,并记录手术时出血量。结果血管造影可清晰显示肿瘤病变范围及供血情况,12例患者中一侧颌内动脉供血8例,合并咽升动脉供血4例。7例完全栓塞,5例仅部分栓塞。毒副作用为栓塞侧面部疼痛4例,无严重并发症发生。所有病变均完整切除。术中平均出血量为470ml。结论鼻咽纤维血管瘤术前栓塞能减少外科术中出血并提高肿瘤切除率。     

鼻咽纤维血管瘤术前供血动脉栓塞的临床价值探讨

目的　探讨鼻咽纤维血管瘤术前栓塞的临床价值。方法　 2 9例鼻咽纤维血管瘤 ,其中 2 0例行IADSA及栓塞 ,9例直接手术切除 ,供血动脉主要为颈外动脉的颌内和 /或咽升动脉 ,栓塞物为明胶海绵。结果　栓塞后 90 %肿瘤血供完全消失 ,未行栓塞与栓塞后手术平均出血量分别为 115 0ml、80 0ml和 45 0ml、3 0 0ml,二者差异显著 (P <0 .0 5 )。栓塞后 14例瘤体不同程度缩小 ,6例无变化 ,15例瘤周水肿明显 ,栓塞后 48～ 72h手术最为理想。结论　鼻咽纤维血管瘤术前栓塞是临床有效的治疗方法之一。     

数字减影血管造影栓塞术治疗鼻部疾病围手术期护理16例

1998．2003年，我科应用数字减影血管造影栓塞术(digital subtraction angiography，DSA)治疗顽固性鼻出血6例、鼻咽纤维血管瘤术前行血管造影栓塞术10例，效果良好，现将DSA围手术期护理报告如下。     

鼻咽纤维血管瘤手术前介入栓塞的临床应用

目的:探讨鼻咽纤维血管瘤术前介入栓塞的临床价值。方法:回顾分析17例鼻咽纤维血管瘤患者的临床资料,其中12例行数字减影动脉血管造影及栓塞,5例直接手术切除。供血动脉主要为颈外动脉的颌内或(和)咽升动脉,栓塞物为明胶海绵。结果:栓塞后10例(占83%)肿瘤血管血供完全消失,8例栓塞后瘤体缩小约2/5,栓塞后48～72h手术最理想。结论:鼻咽纤维血管瘤术前介入动脉栓塞是安全有效的治疗方法之一。     

海绵窦硬脑膜动静脉瘘的DSA分析与栓塞治疗

目的探讨海绵窦硬脑膜动静脉瘘的DSA表现与血管内治疗技术。方法13例患者采用股动脉入路,行选择性颈内、外动脉造影明确诊断后,以聚乙烯醇颗粒和明胶海绵颗粒作为栓塞剂,对9例海绵窦硬脑膜动静脉瘘患者施行颈外动脉硬脑膜支供血的瘘口及供血动脉末梢超选择性栓塞。结果DSA主要表现为患侧海绵窦扩大和眼上静脉扩张。13例海绵窦瘘主要通过眼上静脉引流;3例有不同程度“偷流”现象;9例患者均成功地闭塞了颈外动脉分支向海绵窦分流的瘘口,同时保持了颈外动脉非供血分支的通畅,所有患者临床症状体征明显改善,随访9~12个月未见复发。结论血管内栓塞技术是治疗海绵窦硬脑膜动静脉瘘的最好方法,具有微创、安全和疗效确切的优点。超选择性血管造影诊断及栓塞剂颗粒大小适当是栓塞成功的重要条件。     

超选择性血管内栓塞治疗严重鼻出血22例分析

目的：探讨严重鼻出血超选择性血管内栓塞治疗的临床疗效。方法：对22例患者行股动脉插管数字减影血管造影（DSA）显示出血血管并行栓塞。结果：DSA证实1例颈内动脉虹吸部假性动脉瘤，1例为蝶窦海绵窦假性动脉瘤，其余20例患者均存在颌内动脉末梢分支畸形或出血征象。本组均行栓塞治疗，鼻出血症状消失，有效率100％。结论：超选择性血管内栓塞治疗颌内动脉或颈内动脉引起的严重鼻出血，是安全和有效的。     

经静脉入路栓塞治疗难治性外伤性颈动脉海绵窦瘘

目的评价经静脉入路栓塞治疗难治性外伤性颈动脉海绵窦瘘（TCCF）的疗效,强调保留颈内动脉通畅的重要性。方法回顾性分析近3年经静脉入路弹簧圈联合Onyx胶栓塞的8例外伤性TCCF,所有病例经动脉入路球囊闭塞瘘口失败,后接受经静脉入路栓塞瘘口,术后3~18个月脑血管造影和临床随访评价其疗效。结果5例单纯经静脉入路栓塞完全闭塞瘘口,2例经动脉入路植入可脱球囊联合经静脉入路栓塞完全闭塞瘘口,治愈率为87.5%;1例经静脉入路栓塞后遗留海绵窦内假性动脉瘤,3个月后复查动脉瘤消失;术中均未出现远端脑栓塞、脑出血症状,2例患者新发外展神经麻痹,术后2~6个月症状逐步改善并最终消失;术后3~18个月随访造影7例瘘口完全闭塞颈内动脉通畅,1例瘘口消失,同侧颈内动脉闭塞;同时所有病例眼部症状及颅内杂音均消失。结论经静脉入路栓塞治疗外伤性颈动脉海绵窦瘘安全有效,为保留颈内动脉,可作为难治性TCCF的一种重要的治疗方法。      

颈内动脉海绵窦瘘的经血管内栓塞治疗

目的:评价颈内动脉海绵窦瘘(CCF)经血管内栓塞治疗的方法及价值。材料和方法:分析14例经血管内介入治疗的颈内动脉海绵窦瘘病例,以带毛弹簧栓、可脱球囊或电解可脱弹簧栓(Guglielmi Detachable Coil,GDC)经动脉或静脉途径栓塞瘘口。6例采用带毛弹簧栓,共54个,其中1例同时经眼静脉穿刺逆行栓塞海绵窦。7例采用球囊栓塞,1例因为瘘口小无法放置弹簧栓和球囊而采用GDC栓塞。结果:本组中13例CCF瘘口完全堵塞,其中4例同时堵塞颈内动脉,患者症状消失。1例已有6年病史的CCF颈内动脉参与大脑供血无法栓塞,经栓塞与海绵窦相通的颈外动脉后,又经眼静脉栓塞海绵窦致瘘口明显缩小。结论:经动脉内以球囊、弹簧栓或GDC栓塞是治疗CCF的有效方法,其中以球囊栓塞操作安全简便为首选材料。引流静脉粗大者逆行栓塞可以起补充作用。     

超选择性全脑血管造影及栓塞治疗外伤性顽固鼻腔大出血

目的：探讨外伤性顽固性鼻腔大出血行超选择性全脑血管造影及血管内栓塞治疗临床应用价值。方法：回顾分析34例患者全脑血管造影与超选择性血管内栓塞治疗的资料。结果：27例颈外动脉分支出血,其中1例蝶腭动脉伴副脑膜动脉同时破裂出血;7例发生颈内动脉海绵窦瘘;微导管超选择性靶血管插管后采用明胶海绵、PVA颗粒、弹簧圈、可脱性球囊等栓塞;2例再发鼻出血经填塞后缓解,其余一次栓塞止血成功;1例术后发生偏盲。结论：全脑血管造影是明确外伤性顽固鼻腔大出血责任血管的“金标准”,超选择性血管内栓塞是微侵袭、安全、有效的首选治疗方法。     

An Unusual Case of Epistaxis—Juvenile Nasopharyngeal Angiofibroma

Background: Epistaxis is a common complaint seen in the younger population. Its etiology is typically from the anterior nares, although we present a case of epistaxis from an uncommon source—juvenile nasopharyngeal angiofibroma. Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascular, benign, yet locally invasive tumor that occurs in preadolescent males. Objectives: To illustrate a case of epistaxis from an uncommon source. Case Report: A 21-year-old man with a past medical history of allergic rhinitis presented to the Emergency Department (ED) after 6 months of intermittent yet worsening epistaxis. He described the bleeding as sudden onset that resolved after 30 min of direct compression of the external nares. He denied any history of digital manipulation, trauma, or bleeding disorders. Upon arrival in the ED, he had brisk bleeding from the right naris that was initially controlled with phenylephrine nasal spray. A small round friable mass was visualized in the right posterior nasal cavity. Further hemostasis of the epistaxis was achieved using a nasal tampon moistened with phenylephrine, and a computed tomography scan of the sinus revealed a soft tissue mass almost completely occupying the sphenoid sinus and extending into the nasopharynx and posterior ethmoids. There was also expansion and bony erosion of the right pterygopalatine fossa. A final diagnosis of JNA was made and the patient was given follow-up with an otorhinolaryngologist, who ultimately surgically resected the mass. Conclusions: JNA is a highly vascular, benign, yet locally invasive tumor that occurs in preadolescent males. This case illustrates the importance of appreciating the more uncommon cases of epistaxis, especially when conventional methods of treatment have initially failed.     

Endovascular treatment of a direct post-traumatic carotid-cavernous fistula with electrolytically detachable coils

Carotid-cavernous fistulae are abnormal communications between the internal carotid artery and venous compartments of the cavernous sinus. Fistulae are uncommon but well-documented sequelae of craniofacial trauma. The characteristic clinical presentation includes ocular pain, chemosis, exophthalmus and visual disturbances. We report on a 28-year-old man with a history of severe craniocerebral injury, including multiple craniofacial fractures resulting from a fall from a height of approximately 6 meters, who was surgically treated one year ago. Two months before presentation, the patient began to exhibit progressive chemosis, proptosis, eyelid swelling, diplopia and exophthalmus. Computerized tomography and computerized tomographic angiography revealed findings consistent with a carotid-cavernous fistula of the right side of the cavernous sinus with dilatation of the right ocular vein. Digital subtractional angiography of the right internal carotid artery revealed a fistula between the cavernous part of the artery and the right cavernous sinus. There was only minimal blood flow in the supraclinoid part of the internal carotid artery because of the high pressure within the fistula. Our decision was to try to occlude the fistula by means of endovascular embolization. The origin of the fistula in the internal carotid artery was successfully obliterated with seven electolytically detachable coils. Control digital subtractional angiography at the end of the procedure demonstrated minimal residual flow through the fistula. Two months after the treatment, angiographic control revealed complete obliteration of the fistula. Clinical examination showed total resolution of signs and symptoms of a carotid-cavernous fistula. Endovascular transarterial embolization of carotid cavernous fistulae is a widely accepted, safe and successful treatment option. In the case that we describe we occluded the fistula and right cavernous sinus with electrolytically detachable coils that we could place into the sinus. Other endovascular treatment options include the use of detachable balloons, stent placement, transvenous embolization or surgical ligation of the fistula.     

外伤性颈内动脉海绵窦瘘的血管内栓塞治疗

[摘要]目的 探讨外伤性颈动脉海绵窦瘘（TCCF）的血管内栓塞治疗效果。方法 回顾性分析我院经股动脉入路行可脱球囊栓塞TCCF瘘口的2例患者临床资料。结果 2例患者均行可脱球囊栓塞，其中1例栓塞球囊2枚后均泄漏，1例假性动脉瘤形成，而均栓塞颈内动脉，成功治愈。结论 血管内可脱球囊栓塞是临床治疗TCCF的首选有效方法，必要时颈内动脉闭塞也是安全可行、有效。     

海绵窦区硬脑膜动静脉瘘的诊断与治疗

目的:探讨海绵窦区硬脑膜动静脉瘘(CSDAVF)的诊断及治疗.方法:CSDAVF患者15例,均经全脑血管造影证实,1例行颈动脉压迫,14例行血管内栓塞,其中9例经静脉途径,3例经动脉途径,2例经动脉和静脉途径联合栓塞.结果:3例单纯颈外动脉供血患者经动脉途径栓塞术后复查2例治愈,1例部分栓塞,眼部症状明显改善;经静脉途...     

颈内动脉系统血管内治疗技术的临床探讨

目的 探讨颈内动脉系统血管内治疗技术与效果。方法 采用股动脉入路、颈内动脉选择性插管的方法,行脑癌区域性化疗5例、CCF栓塞治疗6例共14次。治疗前先行全脑血管造影,CCF加行压颈功能试验。结果 14例次颈内动脉介入操作技术成功率为100％,无任何严重并发症;所有患治疗后均症状缓解或消失。脑癌介入化疗后均有瘤体缩小和瘤周水肿减轻改变。6例CCF球囊栓塞后5例达到影像学痊愈且保持了人动脉通畅;1例瘘口巨大同时闭塞了颈内动脉。结论 颈内动脉介入性脑癌化疗及CCF闭塞术较为安全、有效。