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。     

应用动脉栓塞治疗难治性鼻出血

在北美和欧洲 ,动脉栓塞已成为治疗难治性鼻出血的常规手段之一 ,治疗无效时方采用动脉结扎。在爱尔兰 ,该技术的作用尚未定论。该作者回顾分析都柏林两家医院 1998～ 2 0 0 0年间行动脉栓塞治疗的 12例严重鼻出血患者 ,所有病人均经过常规治疗 ,包括局部压迫、血管收缩剂、化学烧灼、鼻腔和后鼻孔填塞 ,仍反复出血。局麻下经皮穿刺股动脉插管 ,首先用碘基低渗造影剂 Niopam行颈内和颈外动脉造影 ,若病变部位难以确定 ,则行双侧造影。然后将导管深入上颌动脉系统 ,行选择性动脉造影以确定需要栓塞的部位 ,在监视器下经微导管注入钨或钢质微…     

难治性鼻出血的超选择性动脉栓塞术

作者报道6例难治性鼻出血的超选择性动脉栓塞。男4,女2,54～75岁。半数伴有高血压,1例伴有偏瘫。6例患者均为颈外动脉分支-上颌动脉所致的鼻腔后部出血。5例采用 Seldinger氏法经股动脉插管,伴有偏瘫的1例采用切开皮肤,颞浅动脉插管;导管尖端均起选至脑膜中动脉起始后的上颌动脉内;栓塞剂用钢圈加1×1×1mm的明胶海绵碎片,先将钢圈送入数枚,血流明显减弱后再经导管推送明胶海绵直至血流完全阻断。栓塞后鼻出血立即停止,随访1～23个月均无复发。认为该方法无外科性创伤,能直接发现颈外动脉血管异常及出血点,手术后患者也可实施,能选择性阻     

超选择性颈外动脉分支栓塞治疗顽固性鼻出血

目的：介绍一种治疗顽固性鼻出血快速有效的方法。方法：应用数字减影(digital subtraction angiography，DSA)技术行超选择性颈外动脉分支颌内动脉和/或面动脉栓塞，使鼻腔后部出血区的血供明显减少，以达到止血的目的。结果：11例顽固性鼻出血行栓塞止血，均1次止血成功，观察3～15个月无复发。没有发生任何严重的并发症。结论：应用DSA对治疗顽固性鼻出血既能明确定位诊断又能快速有效止血，而且栓塞区的动脉分支在一定时间后，可以再通或形成侧支循环。     

选择性血管内栓塞治疗难治性鼻出血的临床分析

目的：了解选择性血管内栓塞治疗难治性鼻出血的疗效及影响疗效的因素。方法：23例难治性鼻出血患者在颈动脉数字减影血管造影(DSA)的基础上行选择性颌内动脉末梢病变血管内栓塞，其中5例同时栓塞面动脉。结果：DSA证实23例患者均存在颌内动脉末梢发育不良或畸形，15例伴有出血征象，6例并面动脉形态异常。治愈22例，其中l例24h内复发鼻出血者证实有新侧支供血，经补加栓塞后出血停止，治愈率为95．6％。l例治疗失败，与栓塞前去除鼻腔填塞物有关，且不能除外有面动脉出血。结论：难治性鼻出血与颌内动脉发育不良及畸形有关，选择性血管内栓塞治疗能收到迅速而满意的疗效。治疗失败与潜在侧支开放或面动脉出血有关，过早去除鼻腔填塞物也是影响栓塞疗效的因素。     

鼻腔后部出血选译性颌内动脉栓塞术

作者以选择性颌内动脉栓塞术治疗难制止的鼻腔后部出血5例:其中3例按Seldinger 氏法自右股动脉插管,管径6.5F;高龄者2例,70～75岁,考虑有动脉硬化而自颈总动脉插管,管径5F。均先做出血侧颈外动脉造影,然后将导管送入颌内动脉。在透视下将小片明胶海绵约1×2×5mm 混于造影剂中,作颌内动脉造影的同时将之栓塞。有出血性素质、造影剂过敏、严重高血压或肾功能不良者禁用。本组5例原因不明特发性鼻出血经血管栓塞后观察2～9个月,无一例再出血。本法无需外科手术,颈外动脉造影尚可发现异常血管找到出血点。上颌窦术后、上颌窦发育不良者作颌内动脉结扎有困难,采用本法则简便有效。但将导管插入颌内动脉需专门训练。合并症有面神经部分麻痹、牙关紧闭、面部疼痛     

颌骨中央性血管瘤的诊断和治疗

目的:探讨颌骨中央性血管瘤的诊断和治疗方法及急症止血措施.方法:对1984至1999年收治的颌骨中央性血管瘤3例结合文献进行临床分析.结果:病变部位:上颌骨2例,下颌骨1例,同时合并上唇龈颊软组织血管瘤1例;均经手术治愈,拔牙后大出血先行急症止血1例、上颌骨部分切除2例,下颌骨部分切除一期成形1例;双颈外动脉及同侧颈总动脉结扎1例,选择性颌内动脉栓塞、颈外动脉结扎1例.结论:发生于上颌骨者,手术难度及术中出血量均明显大于下颌骨者.拔牙后出现难以控制致命性大出血者应考虑本病;DSA及超选择性颌内动脉栓塞术有助于明确病灶的血供情况及减少术中出血;手术切除是本病唯一的根治方法;低温麻醉及自体血回输可减少出血量及输血并发症.     

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。     

血管栓塞术治疗鼻出血114例次回顾性分析

选择性血管栓塞术已成为传统方法不能控制的难治性后鼻孔出血的有效治疗手段。该文回顾分析１９９０～１９９５年间应用选择性血管栓塞术治疗的难治性鼻出血１０７例患者１１２次住院的疗效。患者年龄１３～８８岁，平均５５岁。病因：特发性鼻出血９２例（８７％），鼻及鼻窦手术后２周内出血者１０例，面部创伤后２周内出血者４例，肿瘤性出血１例。特发性鼻出血的相关性危险因素有：高血压３７例，眼用阿斯匹林或其它非类固醇抗炎药物２０例，抗凝治疗４例，肾衰３例，另有３８例不明。手术方法：先经皮股动脉插管，行选择性同侧颈内、外…     

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.     

顽固性鼻出血的治疗

目的 探讨不同治疗方法对顽固性鼻出血的意义。方法 224例顽固性鼻出血病例中,50例行颈外动脉结扎,35例行筛动脉结扎,鼻内镜下治疗139例,鼻咽填塞3例。结果 224例中,随访3个月,颈外动脉结扎者复发率22.00%,筛动脉结扎者复发率17.14%,鼻内镜下治疗者复发率4.32%。结论 应用鼻内镜辅助检查明确出血灶后局部止血效果明显,且复发率低。     

Treatment of intractable epistaxis using arterial embolization

Arterial embolization has become the procedure of choice for managing intractable epistaxis in certain centres in North America and Europe, with arterial ligation reserved for those patients in which it fails. In Ireland, the role of this relatively new technique is poorly defined. The aim of this retrospective study was to investigate the outcome of all patients who underwent arterial embolization for intractable epistaxis in Dublin since it was introduced in 1998. Embolization resulted in complete and immediate resolution of epistaxis in 10 out of 12 patients (82%). Two patients required carotid ligation because of persistent epistaxis. One other patient had a further minor epistaxis 2 days following embolization, which was treated successfully with cautery. No major complications occurred in any of the patients. This study suggests that arterial embolization is an effective and safe method of managing patients with intractable epistaxis.     

顽固性鼻腔后部出血的手术治疗

本文综述了近年国外对顽固性鼻腔后部出血手术治疗的相关文献，对前-后鼻腔填塞术、颈外动脉结扎术、血管造影颌内动脉栓塞术、鼻内镜下经鼻腔蝶腭动脉结扎术等手术方法及其疗效进行分析，提出对顽固性鼻腔后部出血病人应根据具体情况选择最合适的手术治疗方法。     

An evaluation and clinical study of severe epistaxis treated by arterial ligation

Forty-three cases of intractable epistaxis treated by major arterial ligation are described, with follow-up in 41 cases of up to 11 years. It would appear that this treatment is effective in the control of epistaxis, and there was no evidence of any long-term detrimental effect on the nose, or of any significant mortality. External carotid artery ligation is advocated in the elderly and debilitated case, whilst internal maxillary artery ligation together with anterior ethmoidal artery ligation is indicated in the younger age group, or in the elective case. Evaluation of the results is discussed together with alternative methods of management.     

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.     

Management of intractable epistaxis in patients who received radiation therapy for nasopharyngeal carcinoma

To report clinical manifestations, bleeding point localization, and outcomes of management in 16 patients with 16 instances of intractable epistaxis after radiation therapy for nasopharyngeal carcinoma. Retrospective chart review of 16 patients with nasopharyngeal carcinoma (mean age 52.06 ± 14.37 years) with 16 instances of intractable epistaxis during the past 5 years, whose diagnosis was confirmed by angiography (n = 10) or MRI/CT imaging studies and clinical manifestations (n = 6). The mean radiation dose to the affected carotid artery was 101.37 ± 34.85 Gy. Bleeding points were detected in the internal carotid artery (n = 8) or external carotid artery (n = 8). Detachable balloons were used in one affected artery for vascular occlusion; six were treated using an absorbable gelatin sponge (n = 4) or microcoils (diameter 1 mm) (n = 2). Endovascular embolization was successful in seven radiation carotid blowout syndromes with cessation of hemorrhage. One patient underwent external carotid artery ligation and one patient recovered without treatment. The clinical follow-up was 3 months. Therapeutic endovascular embolization of intractable epistaxis is both efficient and safe. It should be considered as the primary treatment modality in intractable epistaxis of nasopharyngeal carcinoma.     

Combined internal maxillary and anterior ethmoidal arterial occlusion: the treatment of choice in intractable epistaxis.

Whilst it is generally accepted that the standard management for anterior or benign epistaxis is either cautery or anterior nasal packing, that of posterior or intractable epistaxis remains controversial. Various modalities of treatment, ranging from posterior nasal packing to arterial ligation and embolization, have been advocated but none have been unanimously accepted as the treatment of choice. The purpose of this paper was to determine the efficacy of internal maxillary arterial ligation versus combined internal maxillary arterial ligation and anterior ethmoid arterial coagulation in intractable epistaxis. Over a six year period, from 1985 to 1990, 454 patients were admitted and treated for epistaxis. Forty-seven patients were diagnosed as having intractable epistaxis on the basis that the epistaxis failed to settle on anterior nasal packing. They were moved to the next step in management, which was combined anterior and posterior nasal packing. There were 30 failures, one was found to have choriocarcinoma of the maxilla, and was treated with cytotoxics, and the other 29 were moved to the next step, which was arterial ligation. Fifteen patients had internal maxillary arterial ligation, and 14 combined internal maxillary arterial ligation and anterior ethmoidal arterial coagulation. Large windows were created in both the anterior and posterior walls of the maxillary sinuses and all identifiable branches of the internal maxillary artery were dissected out carefully and two medium size ligating clips were placed over the main trunk, the sphenopalatine and the descending palatine branches. Single clips were placed on all other identifiable branches. Coagulation of the anterior ethmoidal artery was performed with a bipolar cautery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Direct cauterization of the nasal septal artery for epistaxis

Emergency management of epistaxis may include the use of local pressure and vasoconstrictors, chemical or electric cautery, hemostatic agents, nasal packing, embolization, and surgical arterial ligation. There is no definitive protocol for the management of epistaxis, although various protocols have been proposed in the literature. As approaches to surgical ligation of the arterial supply of the nasal cavity have evolved from external carotid ligation to minimally invasive approaches, surgical management of epistaxis has become more effective than embolization and may be less risky. In the surgical management of epistaxis, arterial ligation immediately proximal to the bleeding site is preferred. We propose a simple variation of the endoscopic sphenopalatine artery ligation that may be used to manage epistaxis arising from the nasal septum and floor.     

鼻出血的治疗(附79例病例分析)

目的：总结鼻出血的治疗经验，分析治疗中可能存在的问题，探讨各种治疗措施在处理鼻出血中的意义。方法：对近6年来住院治疗的鼻出血病人79例进行回顾分析。结果：79例均治愈，治疗手段包括前后鼻孔填塞、内镜下激光烧灼、颈外动脉和/或筛前动脉结扎、经上颌窦颌内动脉结扎或数字减影血管造影颌内动脉栓塞等。结论：治疗鼻出血的关键是找淮出血部位及明确出血原因，并根据病人实际情况采取有效止血措施。