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。     

血管造影栓塞术治疗顽固性鼻出血

为探讨血管造影栓塞术治疗顽固性鼻出血的疗效，对８例经多次后鼻孔填塞失败的顽固性鼻出血患者，在荧光屏透视下行超选择血管栓塞术９次，全部栓塞成功，无一例出现严重并发症。表明血管栓塞术是一种安全，有效的止血方法，尤其对全长或伴有其它疾病的无罪性鼻出血患者，在保守治疗失败的情况下，该术式是治疗的最佳选择。     

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     

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。     

超选择性颈外动脉分支栓塞术在难治性鼻出血中的应用

目的:探讨经微导管超选择性颈外动脉分支栓塞术在治疗难治性鼻出血中的应用价值。方法:46例难治性鼻出血患者,首选超选择性颈外动脉分支栓塞术者36例,首选颈外动脉结扎者10例。结果:36例首选颈外动脉分支栓塞术者1次性治愈32例(88.9%),10例首选颈外动脉结扎者1次性治愈4例(40.0%)。前者平均住院4.8d,后者平均住院10d。复发患者均经综合方法有效止血,并发症少。结论:经微导管超选择性颈外动脉分支栓塞术治疗难治性鼻出血简便、安全、有效,疗效明显优于颈外动脉结扎,综合运用多种方法能有效治疗难治性鼻出血。     

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。     

数字减影血管造影及栓塞术治疗头颈部疾病的严重并发症

报告3例介入治疗发生脑梗塞并发症，其中2例立即给予经导管溶栓治疗的病人死亡。对并发症的发生原因和溶栓治疗等问题进行讨论。同时建议头颈部疾病的血管栓塞和动脉溶栓治疗应慎重选择应用。     

海绵窦颈内动脉损伤所致严重鼻出血的血管内栓塞…

报告海绵窦颈内动脉损伤引起严重鼻出血２例，其中１例为突入蝶窦的巨大假性动脉瘤，１例为已进行守颈总动脉结扎和开颅颈内动脉夹闭术的颈内动脉海绵窦瘘，分别采用经股动脉行颈内动脉栓塞和经眼静脉行颈内动海绵窦瘘栓塞治疗，取得满意效果。     

鼻出血行2次介入栓塞术后致严重急性脑梗死1例

患者,女,41岁.以主诉"头晕眼花3年,右鼻腔出血3 h"入院.3年前发现高血压,最高达190/110 mmHg(1 mmHg=0.133 kPa),曾口服卡托普利25 mg(每日3次)、北京降压0号(1粒,每日3次),血压控制在110～140/85～95 mmHg之间.本次发病为右鼻腔突然大量出血(具体量不详),速度快,但未发现出血部位,用凡士林油纱条填塞鼻腔,出血止.     

鼻出血血管造影栓塞治疗的护理

鼻出血是耳鼻咽喉科常见病，也是急重症之一。多数学者主张，如果手术治疗失败，就需进行以血管造影方法栓塞供应鼻腔血源的末梢血管。随着血管造影技术的改进和被广泛应用，此法被积极用于治疗鼻出血患者，其地位与手术治疗并列，且有效率高于手术治疗。此法可以直接看到出血部位及其邻近的血管，因此可以尽量靠近末梢处栓塞血管，避免来自侧支循环所致的再次出血，减轻患者痛苦。     

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.     

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。     

吸凝器在治疗难治性自发性鼻出血中的应用

目的 分析总结鼻内镜下应用吸凝器治疗难治性自发性鼻出血的经验体会。方法 应用鼻内镜和吸凝器定位并电凝出血点,结合藻酸钙纱条局部填塞治疗29例难治性自发性鼻出血。结果 本组病例均一次治愈,术后随访2个月无复发。结论 用吸凝器在鼻内镜下治疗难治性自发性鼻出血不但快速、有效,而且安全、经济、实用。     

Selective embolization in the treatment of intractable epistaxis

CONCLUSIONS: In skilled hands, selective embolization is a safe procedure and represents an effective treatment for prolonged epistaxis. Embolization therapy can be repeated if necessary. OBJECTIVE: Severe posterior epistaxis is a common clinical problem in an ENT department and controlling the bleeding may present difficulties. Several methods are used to control posterior epistaxis, one of the latest treatment strategies being selective embolization of the nasal arteries. The aim of this study was to describe the effect of selective embolization in 22 patients treated with a total of 30 procedures at the ENT Department of Odense University Hospital between January 1995 and March 2004. To our knowledge this is the first Nordic work in which selective embolization has been used as a treatment strategy for patients with hereditary hemorrhagic telangiectasia (HHT). MATERIAL AND METHODS: This was a retrospective review. Post-treatment effects and complications were evaluated by means of a questionnaire and a telephone interview. Owing to the different treatment strategies used, the results were evaluated for 2 groups of patients: Group A, 9 patients with HHT; and Group B, 13 patients with causes of epistaxis other than HHT. RESULTS: In Group A, 15 procedures were performed, 12 of which were beneficial as the duration and number of episodes of epistaxis were reduced. In Group B, 15 procedures were performed and the success rate was 87%. One patient suffered from skin necrosis at the tip of the nose. No other serious side-effects of the treatment were observed.     

Selective embolization in the treatment of intractable epistaxis

Conclusions. In skilled hands, selective embolization is a safe procedure and represents an effective treatment for prolonged epistaxis. Embolization therapy can be repeated if necessary. Objective. Severe posterior epistaxis is a common clinical problem in an ENT department and controlling the bleeding may present difficulties. Several methods are used to control posterior epistaxis, one of the latest treatment strategies being selective embolization of the nasal arteries. The aim of this study was to describe the effect of selective embolization in 22 patients treated with a total of 30 procedures at the ENT Department of Odense University Hospital between January 1995 and March 2004. To our knowledge this is the first Nordic work in which selective embolization has been used as a treatment strategy for patients with hereditary hemorrhagic telangiectasia (HHT). Material and methods. This was a retrospective review. Post-treatment effects and complications were evaluated by means of a questionnaire and a telephone interview. Owing to the different treatment strategies used, the results were evaluated for 2 groups of patients: Group A, 9 patients with HHT; and Group B, 13 patients with causes of epistaxis other than HHT. Results. In Group A, 15 procedures were performed, 12 of which were beneficial as the duration and number of episodes of epistaxis were reduced. In Group B, 15 procedures were performed and the success rate was 87%. One patient suffered from skin necrosis at the tip of the nose. No other serious side-effects of the treatment were observed.     

鼻内窥镜下诊治难治性鼻出血68例分析

目的：探讨难治性鼻出血常见的出血部位及治疗方法。方法:回顾分析经内窥镜诊治的难治性鼻出血68例的临床资料,分析其出血部位及治疗效果。结果:出血部位在下鼻道顶部占27.9%(19/68)、嗅裂鼻中隔占20.7%(14/68)、中鼻道后上部占16.1%(11/68)、中鼻甲后端蝶腭动脉区和鼻中隔后端均为10.3%（7/68）、鼻咽顶占5.9%（4/68）、Woodruff静脉丛和部位不明均为4.4%(3/68)。1次治愈59例(86.7%),2次9例(13.3%),随访1～3个月均无复发。结论:应用鼻内窥镜检查鼻腔深部的出血并在镜下电凝或填塞止血安全有效。     

鼻内镜下老年人顽固性鼻出血的微创治疗

目的探讨鼻内镜下微创治疗老年人顽固性鼻出血的方法及适应证。方法对32例老年人顽固性鼻出血患者鼻内镜下检查,明确出血部位,使用铬酸局部烧灼、明胶海绵局部填塞止血,回顾性分析出血部位、疗效及治疗方法的选择。结果全部病例可见鼻腔黏膜多处糜烂,出血部位最多见于嗅裂鼻中隔部11例,鼻中隔棘或嵴7例,下鼻道顶部7例,中鼻道4例,中鼻甲后端2例,蝶筛隐窝1例;7例鼻中隔偏曲有棘或嵴致出血者,同期鼻内镜下行鼻中隔偏曲成形术。单独使用铬酸止血16例,单独使用明胶海绵止血7例,联合应用铬酸和明胶海绵止血9例。全部病例1次治愈30例,2次2例,随访3个月无复发。无严重并发症。结论鼻内镜下精确定位出血点是实施微创局部烧灼或填塞止血的关键。