数字减影血管造影在耳鼻咽喉科应用的初步报告

对１１例耳鼻咽喉科疾病进行了数字减影血管造影检查，其中１０例同时行栓塞治疗，通过ＤＳＡ可以了解各种血管瘤的供血来源，病变范围，静脉引流等情况，术前栓塞肿瘤的供血血管，术中出血量明显减少。对外伤性鼻出血，应用ＤＳＡ在直视下辨明血血管，栓塞该血管达到止血目的。对外伤性生动脉瘤，通过ＤＳＡ可确定病变部位，且可同期进行栓塞治愈。并对ＤＳＡ在耳鼻咽喉科应用的适应证，并发症及其预防措施进行了讨论。     

DSA选择性动脉栓塞配合手术治疗鼻咽,鼻窦血管性肿瘤

对６例鼻咽，鼻窦的血管性肿瘤患者，应用数字减影血管造影显示供血来源，病变范围及静脉引流等；采用聚乙烯醇或明胶海绵粉末术前选择性地栓塞瘤体内血管及供血动脉。然后３ｄ内手术切除肿瘤。术中见瘤体明显缩小，界限清晰；出血明显减少，手术经过顺利。表明ＤＳＡ选择性动脉栓塞配合手术治疗该部血管性肿瘤，其效果明显优于单纯手术治疗者。     

数字减影血管造影对严重后鼻部出血的应用价值

报告对３例经多种方法治疗不能止血的严重后鼻部出血患者，以数字减影血管造影查明了不常见的病因；并用之行栓塞治疗，２例出血停止，１例虽栓塞双侧颌内动脉，但未控制出血，改行其他方法血止。表明ＤＳＡ对控制由颌内脉病变引起鼻出血是一种有效的新方法，并就ＤＳＡ栓塞治疗的优点和适应证等进行讨论。     

超选择性血管内栓塞治疗难治性鼻出血

本文对３例严重难治性鼻出血患者采用数字减影血管造影（ｄｉｇｉｔａｌｓｕｂｔｒａｃｔｉｏｎａｎｇｉｏｇｒａ－ｐｈｙ，ＤＳＡ）在影像系统直视下辨明出血的部位和血管，然后应用超选择性血管内栓塞治疗，取得良好的效果，并对应用超选择性血管内栓塞治疗的优越性以及并发症及其预防措施进行讨论。认为应用ＤＳＡ行超选择性血管内栓塞治疗效果准确可靠，病人痛苦小，不但可用于治疗特发性难治性鼻出血，而且也可应用于常规方法止血治疗无效的鼻出血患者     

外耳血管瘤8例报告

目的：搪塞外耳血管瘤的诊治方法，提高其诊治水平，方法：对８便外耳血管瘤患者的临床资料进行回顾性分析。８例均为单侧血管瘤，５例于术前行数字减影血管造影术（ＤＳＡ），其中３例同时行栓塞术。７例行血管瘤切除术，１例未手术。结果：随访１￣５年５例治愈，２例控制，１例未手术者仍带瘤生存，结论：手术是治疗成人血管畸形血管瘤有铲的措施，而 行ＤＳＡ并给予栓塞术 术中行供血动脉动结扎是控制术中出血和取得手术成功的     

超选择性血管内栓塞治疗难治性鼻出血

本文对３例严重难治性鼻出血患者采用数字减影血管造影在影像系统直视下辨明出血的部位和血管，然后应用超选择性血管内栓塞治疗，取得良好的效果，并对应用超选择性血管内栓塞治疗的优越性以及并发症及其预防措施进行讨论。认为应用ＤＳＡ行超选择性血管内栓塞治疗效果准确可靠，病人痛苦小，不但可用于治疗特发性难治性鼻出血，而且也可应用常规方法止血治疗无效的鼻出血患者。     

头颈外科

20020571介人治疗在外伤性颈内动脉病变中的应用/詹晓东…//中华耳鼻咽喉科杂志一2001,36(5)一387 实施颈内动脉完全性栓塞,首先确保will-15环前、后交通支提供良好的血供,栓塞前的MataS试验可使健侧颈内动脉和椎动脉代偿性增加血供。栓塞中球囊闭塞加强试验和交叉代偿循环充盈试验,可观察有无脑部缺血的症状和数字减影片的脑组织供血影像,客观地评价完全性颈内动脉栓塞的患侧大脑血供状况。而在保留颈内动脉的栓塞中,以球囊或电解可脱卸弹簧圈(GDC)经颈内动脉的瘩口释放到海绵窦或假性动脉瘤内经3周左右,GDC在海绵窦或假性动脉瘤内逐渐…     

颈动脉体瘤的诊断及外科治疗

报告手术治疗８例的临床资料，并结合文献详细探讨了本病的诊断要点及治疗措施。提出：①凡颈动脉三角区原因不明的肿块，左右可活动较大而上下活动受限，特别是有搏动感者应怀疑本病；②彩色Ｄｏｐｐｌｅｒ超声检查对诊断本病有较高价值；③数字减影血管造影术（ＤＳＡ）是诊断本病的主要方法。如同时进行供血动脉栓塞，可减少术中出血；④外科手术为首选治疗方法；⑤多于术中视肿瘤的具体情况以决定对颈动脉的处理方式，总结４种治疗方案。     

术前IADSA和栓塞术在鼻咽纤维血管瘤治疗中的应用

目的：研究分析术前经动脉数字减影血管造影（ＩＡＤＳＡ）和栓塞术在鼻咽纤维血管瘤治疗中的价值。方法：分析本院２１例鼻咽纤维血管瘤患者的临床分析治疗资料，１主后１年复发，再次手术治疗。２２次手术中，术前行及未行ＩＡＤＳＡ和栓塞术的各１１次。 术前示行和行ＩＡＤＳＡ和栓塞术的要中平均出血量和输血量。结果：术前未行和行ＩＡＤＳＡ和栓塞术的术中出量量和输血量分别为１１３６ｍｌ、８３６ｍｌ、６７７ｍｌ、４００     

数字减影血管造影及栓塞在鼻咽血管纤维瘤诊断和治疗中的应用

目的 探讨数字减影血管造影(DSA)及栓塞在鼻咽部血管纤维瘤诊断和治疗中的价值.方法 对16例鼻咽部血管纤维瘤进行DSA检查和选择性栓塞肿瘤供血动脉.栓塞后2～7天行鼻内镜下肿瘤切除.结果 DSA检查使鼻咽血管纤维瘤获得明确的诊断,所有病例均主要由同侧的颌内动脉供血,咽升动脉参与供血1例,同侧颈内动脉参与供血1例,16例患者均栓塞成功.鼻内镜下肿瘤全切除者15例,大部分切除者1例,术中出血明显减少,术中及术后无严重并发症.结论 鼻咽血管纤维瘤的数字减影血管造影能显示病变的范围、血供情况及其特征.栓塞有助于减少术中出血,提高手术安全性及全切率,为内镜下手术的必备条件.     

头面部外伤性假性动脉瘤致鼻出血的诊治

目的 探讨外伤性假性动脉瘤引起顽固性鼻出血的临床诊断思路.方法 选择16例外伤后假性动脉瘤病例,男性12例,女性4例,年龄16～41岁,平均25.4岁,回顾性分析该组病例鼻出血的临床特点.结果 该组病例1例死亡,其他患者行血管造影栓塞治疗后均痊愈出院.患者自入院到通过行数字减影血管造影(digital subtraction angiography,DSA)检查明确诊断为假性动脉瘤相隔时间最短为3天,最长为15天,平均为4.5天,患者均有多次行前后鼻孔填塞病史,填塞的次数最少1次,最多达5次,平均2.5次.结论 外伤后反复大量鼻腔出血患者如行前后鼻孔填塞止血效果差,应尽早行DSA检查,明确有无假性动脉瘤存在,诊断明确后行血管造影栓塞治疗.尽可能避免盲目多次的前后鼻孔填塞给患者带来的痛苦,同时也可有效避免因延误诊断造成假性动脉瘤破裂致患者出血死亡的可能.     

Traumatic pseudoaneurysm of the intracavernous ICA presenting with massive epistaxis: Imaging diagnosis and endovascular treatment

Traumatic pseudoaneurysm of the intracavernous internal carotid artery (ICA) is a very rare cause of epistaxis but is a life-threatening clinical situation when left untreated. The authors have experienced four cases of traumatic pseudoaneurysm involving the intracavernous ICA. Delayed massive epistaxes developed 1 to 8 months after trauma and initial transient epistaxis in all four patients. Three of the cases were successfully managed by the detachable balloon occlusion (DBO) of the ICA along with the aneurysm openings. In one case, a large pseudoaneurysm destroying a large area of the central skull base with peripheral blood clot was demonstrated on computed tomography, magnetic resonance imaging, and angiography; this patient died due to massive epistaxis before the trial of DBO. Imaging findings of pseudoaneurysms involving the intracavernous ICA in the four cases are described, and the role of endovascular treatment is discussed.     

头颈部外伤性假性动脉瘤的处理(附4例报告)

目的:探讨外伤性假性动脉瘤的临床表现、诊断及治疗方法。方法:回顾性分析4例外伤性假性动脉瘤的不同处理方法及其随访结果。结果:本组病例均有明显的外伤史,DSA、CT检查可确诊,对于位置与大小不同的外伤性假性动脉瘤,2例行放射介入治疗,2例行手术治疗,疗效良好。结论:头颈部外伤性假性动脉瘤比较罕见,结合放射技术,诊断并不困难;治疗方面适合进行放射学介入治疗的应优先选择介入治疗,必须行手术治疗的患者可在切除动脉瘤的同时尽量缝合血管壁,保持血流通畅,减少并发症。     

颈内动脉虹吸段完全性栓塞治疗创伤性假性动脉瘤

目的　通过数字减影血管造影 (digitalsubtractionangiography ,DSA)技术诊断颅脑外伤所致的颈内动脉 (internalcarotidartery ,ICA)虹吸段假性动脉瘤。方法　对颅脑外伤合并严重鼻出血的患者进行DSA造影 ,筛选出虹吸段ICA假性动脉瘤 6例 ,经脑动脉环侧支循环功能检测 ,对功能良好者进行ICA虹吸段完全性栓塞。结果　 6例经DSA明确诊断为ICA假性动脉瘤 ,5例进行了动脉栓塞 ,其中 4例痊愈 ,1例死亡 ;另 1例脑动脉环侧支循环功能不良 ,未行栓塞 ,行改善侧支循环功能训练时鼻出血死亡。结论　经DSA明确诊断的颈内动脉假性动脉瘤 ,经脑动脉环侧支循环筛选后 ,可行虹吸段颈内动脉完全性栓塞治疗     

Treatment of traumatic pseudoaneurysm through completely embolizing siphon section of internal carotid artery]

OBJECTIVE: Pseudoaneurysm in siphon section of internal carotid artery (ICA) caused by craniocerebral trauma was diagnosed and totally embolized by applying digital subtraction angiography (DSA) technique, with satisfactory results. The clinical application of this technique was discussed. METHODS: The patients suffered from craniocerebral trauma with serious epistaxis were managed in our hospital by DSA. The patients with pseudoaneurysm in ICA were chosen from them. The circular function of Willis circulus in these patients were checked. If it was good, the ICA was totally embolised. RESULTS: Among 32 patients suffered from craniocerebral trauma with serious epistaxis, 6 patients were definitely diagnosed by DSA to have pseudoaneurysm. The embolism was performed in 5 of them. Among these 5 patients, 4 cured, and 1 died. The patient who could not be embolized also died. CONCLUSION: The pseudoaneurysm definitely diagnosed by DSA can be treated by embolizing siphon section of internal carotid artery completely, after checking the compensatory function of side branches in Willis circulus.     

海绵窦颈内动脉损伤(附5例报告)

本文报告5例均经颈动脉造影确诊的海绵窦颈内动脉损伤的患者，其中2例假性动脉瘤，3例动静脉瘘性动脉瘤；2例反复出现严重鼻出血，3例未出现鼻出血。文中对其临床表现、诊断和治疗原则进行了讨论。认为有头部外伤史和眼部症状者，即使无鼻出血，亦应高度怀疑此病，治疗应以血管介入疗法为主，颈部血管结扎仅应是应急时的选择。     

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.     

Epistaxis Originating From Traumatic Pseudoaneurysm of the Internal Carotid Artery: Diagnosis and Endovascular Therapy

Posttraumatic pseudoaneurysm of the internal carotid artery (ICA) is an uncommon but potentially fatal cause of epistaxis. Because the onset of delayed bleeding from the time of injury is variable, prompt diagnosis of cavernous ICA pseudoaneurysm is often a clinical challenge. The relative urgency to evaluate for this disease is highlighted by the morbid nature of this entity. Optimal management demands rapid recognition and treatment to give the best functional outcome. The authors present a case series of six patients with skull base ICA pseudoaneurysm. A unifying feature in the majority of patients is the development of delayed, massive epistaxis. The time course for presentation of delayed life-threatening epistaxis ranged from 5 days to 9 weeks. Two patients exhibited the classic triad of unilateral blindness, orbital fractures, and massive epistaxis. All patients requiring intervention were successfully treated with endovascular embolization techniques that included detachable balloons and coils. The clinical and radiologic findings in this case series are presented. The relevant anatomy, diagnosis, and treatment of traumatic ICA pseudoaneurysm are reviewed. A contemporary treatment strategy is proposed.     

Place of embolization in the treatment of severe epistaxis

On the basis of long-term study on embolization for severe epistaxis, the authors show the different indications and results of this relatively new method; and 54 cases are presented including Rendu-Osler diseases, primary and traumatic epistaxis, or those due to vascular malformation and benign or malignant tumors. Embolization can prove a very effective method in most cases.     

Massive posterior epistaxis. A manifestation of internal carotid injury at the skull base

Severe crushing head injuries can produce massive posterior epistaxis as a result of injury to the internal carotid artery at the skull base. We describe two such cases with traumatic pseudoaneurysm of the internal carotid therapy. They were managed with detachable balloon embolization. The anatomy of the internal carotid artery is reviewed. The diagnosis of pseudoaneurysms and their incidence, clinical presentation, and management are discussed.