难治性鼻出血鼻内镜下止血的疗效分析

目的探讨难治性鼻出血鼻内镜下止血的效果。方法选取我院近3年收治的118例难治性鼻出血住院患者行鼻内镜检查,明确出血点,进行鼻内镜下电凝及微创材料填塞治疗。结果 118例患者经鼻内镜检查后,明确出血点,双极电凝治疗76例,明胶海绵填塞30例,局部膨胀海绵填塞12例。随访3个月,1次治愈98例(83.05%),2次治愈19例(16.10%),3次治愈1例(0.85%)。结论难治性鼻出血的常见出血部位多发生在嗅裂区、下鼻道穹隆顶部、中鼻道后端、鼻中隔后端,鼻内镜检查可明确出血点的位置,从而有针对性地进行止血,是一种微创且有效的治疗方法。     

难治性鼻出血的诊治

目的:探讨难治性鼻出血的出血部位及检查治疗方法.方法:对62例经2次以上常规填塞未能止血的难治性鼻出血患者进行回顾性分析.结果:出血部位依次为:下鼻道后段、嗅裂区、中鼻道后段、鼻中隔后缘、鼻咽静脉丛.62例患者中51例1次填塞成功,10例经2次填塞,1例填塞无效,后经动脉造影血管栓塞治疗.随诊1个月,无复发病例.结论:详细的纤维鼻咽镜或鼻内镜检查对探察鼻腔深部出血具有重要意义,是止血的关键.     

经鼻内镜电凝治疗下鼻道出血20例报告

鼻出血是临床常见病,出血部位多位于鼻中隔前端.下鼻道出血较少见,出血部位隐蔽,易被临床医生忽视,且前后鼻孔填塞无法直接压迫出血点,止血困难,故常反复出血,出血量大.2002年至今,我科共收治鼻出血病人121例,其中20例为下鼻道出血,圴在鼻内镜下以电凝止血,疗效较好,现报道如下.     

鼻内镜下处理顽固性鼻腔深部出血50例

目的总结鼻内镜下处理顽固性鼻腔深部出血的经验。方法对50例顽固性鼻腔深部出血患者,在鼻内镜引导下运用双极电凝、高频电刀结合套有一段输液器管的直头吸引管或上颌窦吸引管进行出血部位的烧灼止血,然后用明胶海绵微型填塞。2例患者电凝后出血凶猛,采用细短碘仿纱条局部加压填塞,填塞纱条于72 h～7 d内分次取出。治疗后鼻孔区一般不填塞。结果 50例均明确出血点,其中嗅裂鼻中隔部24例(48.0%)、下鼻道后穹隆8例(16.0%)、中鼻道后下部10例(20.0%)、下鼻道前上端4例(8.0%)、鼻咽部4例(8.0%)。50例中,单纯烧灼23例,烧灼+局部明胶海绵填塞25例,烧灼+碘仿纱条局部填塞2例。鼻内镜止血术后未出血45例,再出血5例。再出血时间和例数分别为术后当天1例,术后第1天2例,第2天2例,经综合治疗出血停止。治疗后无一例鼻腔粘连或鼻中隔穿孔发生。结论鼻内镜下诊治顽固性鼻腔深部出血效果好,患者痛苦小、容易接受。     

鼻内窥镜下治疗后鼻孔出血的优势

目的：探讨后鼻孔出血之临床特点及鼻内镜下治疗后鼻孔出血的临床应用效果。方法分析后鼻孔出血鼻内镜下治疗的临床资料。结果60例后鼻孔出血患者,下鼻道穹窿部出血22例（36．6％）,嗅裂区18例（30％）,中鼻甲后端附着处15例（25％）,鼻中隔突起处的后方出血3例（0．05％）。40岁以上后鼻出血发生频率依次易发生于下鼻道穹窿部、嗅裂区、中鼻甲后端附着处;40岁以下后鼻出血发生频率依次易发生于中鼻甲后端附着处、下鼻道穹窿部、嗅裂区;经统计学分析后鼻孔出血部位在40岁以上及以下年龄组之间存在统计学差异（P＜0．05）。所有患者均治愈,随访6个月,有2例再次出血,行方法再次治疗后治愈,其余均未在出血。结论对于不同年龄组的后鼻孔出血患者,窥察寻找出血点时应分别有所侧重。鼻内镜下治疗后鼻孔出血经济、实用、疗效确切,可作为治疗后鼻孔出血的首选方法之一。     

鼻内镜下治疗下鼻道后端出血128例临床分析

出血是耳鼻咽喉科常见急症之一,轻者仅为涕中带血,重者可因出血过多引起出血性休克,反复出血可导致贫血。诊断鼻出血虽不困难,但要迅速而有效地止血并不容易。应在短期内查清出血部位,判定出血原因和估计出血量,以便及时采取有效措施。对一时不能查清病因者,需先行止血。传统的鼻腔填塞法包括前鼻孔填塞和后鼻孔填塞。鼻腔前端（如黎氏区或下鼻甲前端）的出血大多可窥及,可行前鼻孔填塞;反复发作的顽固性鼻出血的患者出血点大多较为隐蔽,一时不易找到,需行后鼻孔填塞,此时患者痛苦较大,且填塞时多存在盲目性,常不能准确压迫出血点导致止血不彻底而反复出血反复填塞,这样就容易损伤鼻腔黏膜,导致黏膜广泛糜烂渗血、鼻腔粘连,且增加鼻腔感染概率,易引起鼻窦炎、中耳炎等并发症［1,2］。军事医学科学院附属医院系全军血液病中心,鼻腔出血患者甚多。军事医学科学院附属医院耳鼻咽喉科于2011年11月至2013年10月采用电视鼻内镜下多功能微波电凝止血及下鼻道填塞治疗下鼻道后端出血128例,效果满意,现报道如下。     

鼻内镜下低温等离子刀治疗鼻出血疗效观察

鼻出血传统的方法多采用前后鼻孔凡士林纱条填塞,微波止血以及化学烧灼等。但由于鼻腔出血部位多较隐蔽,往往填塞不到位,而使止血不彻底。鼻内镜、低温等离子刀等新技术的发展,为治疗鼻出血提供了安全、有效的新途径。我科自2004年7月1005年6月共收治鼻出血94例,经治疗均取得了明显的止血效果,现报告如下。     

阿司匹林二级预防患者鼻出血经鼻内镜止血治疗的效果

目的 探讨阿司匹林二级预防患者鼻出血经鼻内镜治疗的效果。方法 2011年9月~2014年9月本院收治阿司匹林二级预防鼻出血患者78例,随机分为两组,各39例。对照组给予局部填塞止血,观察组给予鼻内镜下微波凝固止血治疗,评估两组止血效果,观察术后恢复情况,统计两组术后3个月内再出血率、黏膜变化率、出现综合反应率。结果 观察组止血有效率为97.44%,显著高于对照组的79.49%(P<0.05);观察组3个月内再出血率、黏膜变化率、综合反应发生率均显著低于对照组(P<0.05),止血时间、鼻黏膜恢复时间、鼻腔通气时间均短于对照组(P<0.05)。结论 鼻内镜止血治疗阿司匹林二级预防患者鼻出血安全有效,能够缩短止血时间,降低再出血率。     

三级方案治疗鼻出血67例

鼻出血（epistaxis）是耳鼻咽喉科的常见急症，治疗原则是迅速查找出血部位和快速、有效止血。2004年10月以来，我们分别应用鼻腔填塞、鼻内镜下微波治疗，以及数字减影血管造影（DSA）上颌内动脉栓塞三级方案，治疗鼻出血67例，疗效满意。现报告如下。     

微波和鼻腔填塞治疗鼻Woodruff区出血28例

鼻Ｗｏｏｄｒｕｆｆ区出血的治疗 ,受设备及视野的限制 ,常不得不改行后鼻孔栓塞。为此 ,我科采用微波和鼻腔填塞治疗鼻Ｗｏｏｄｒｕｆｆ区出血 2 8例 ,疗效较好。1　临床资料1 1　一般情况　 2 8例 (31侧 )中 ,男 18例 ,女 10例 ;年龄 38～ 75岁 ,平均 56岁。反复行前鼻腔填塞9例 ,后鼻孔栓塞 2例。1 2　止血方法　清除鼻腔内积血 ,将浸有 1%麻黄碱及数滴 1%丁卡因棉片依次放入下鼻道、总鼻道 ,3ｍｉｎ后依次取出棉片 ,根据血迹浸湿部位以判断出血位置 ,并重复上述操作 ,收缩鼻甲粘膜 ,以减少出血量。如发现Ｗｏｏｄｒｕｆｆ区出血 ,根据鼻…     

中鼻道息肉与中鼻甲高度关系的CT研究

目的；研究中鼻道息肉与中鼻甲高度的关系，以及鼻腔喷布麻黄碱后CT冠状面扫描诊断中鼻道息肉的价值。方法：回顾分析临床疑有鼻窦炎、鼻息肉且手术病理（40例）、鼻腔镜（62例）及CT检查资料完整的102例。CT检查前双侧鼻腔喷布1％麻黄碱并嘱病人仰卧，头呈过伸位5min 以上。病人仰卧于检查床上，行鼻腔与鼻窦轴面与冠状面CT扫描，层厚2mm，高分辨率重建，分别观察鼻腔黏膜收缩情况与中鼻道软组织肿物（息肉）。将中鼻甲与半月裂的关系分为裂上型（中鼻甲下缘高于半月裂），裂口型（中鼻甲下盏与半月裂位于同一水平），裂下型（中鼻甲下缘低于半月裂），测量并统计裂下型中鼻甲彪月型水平至鼻甲下缘的长度，并与中鼻道息肉发生情况对照。结果：102例中CT扫描鼻腔黏膜收缩满意、尚满意、病变显示清楚者98例；鼻腔黏膜收缩差者4例。102例中47例71侧CT诊断为中鼻道息肉,并经手术和（或）临床证实。102例204侧中中鼻甲为裂上型18侧，发生中鼻道息肉11侧（61．1％）；裂口型38侧，发生中鼻道息肉28侧（73．7％）；裂下型148侧，发生中鼻道息肉32侧（21．6％），明显少于列上型和裂口型者，差异具有非常显著性意义（P值均＜0．01）。结论：鼻腔喷布麻黄碱后CT冠状面扫描简单易行，可很好显示鼻腔内占位，尤其是鼻炎鼻腔黏膜肿胀时的鼻黏膜息肉。中鼻甲发育小、下缘高者中鼻道息肉发生率增高，可能与中鼻道暴露，易受吸入气体冲击而损伤有关。     

Endovascular treatment of epistaxis in patients with hereditary hemorrhagic telangiectasia

BACKGROUND AND PURPOSE: The treatment of epistaxis in patients with hereditary hemorrhagic telangiectasia can be very challenging. The purpose of our study was to evaluate our experience with endovascular epistaxis embolization in patients with hemorrhagic hereditary telangiectasia and to compare this with our experience in patients treated for idiopathic epistaxis.MATERIALS AND METHODS: Over a 6-year period, we treated 22 patients with epistaxis by using endovascular embolization. Twelve of 22 patients had hereditary hemorrhagic telangiectasia; 10 patients had idiopathic epistaxis. The angiographic findings, efficacy of treatment, and complications for both groups were compared.RESULTS: Patients with hereditary hemorrhagic telangiectasia had angiographic abnormalities in 92% of cases compared with only 30% in the idiopathic epistaxis group. Compared with a group of 10 patients treated for other causes of epistaxis, those with hereditary hemorrhagic telangiectasia required significantly more re-embolization treatments or additional surgical procedures because of continued or recurrent bleeding episodes after embolization (P = .03). Complications were rare; a single patient in the idiopathic epistaxis group had a self-limited groin hematoma and postembolization facial pain.CONCLUSION: Endovascular embolization of epistaxis is a safe procedure that can be useful for patients with severe acute epistaxis or chronic persistent bleeding. Patients who undergo endovascular embolization for epistaxis related to hereditary hemorrhagic telangiectasia require repeat embolization and subsequent surgical procedures more often than those with idiopathic epistaxis.

Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu disease, is a hereditary disorder involving vascular abnormalities of various organs. Epistaxis from telangiectasias of the nasal mucosa is a common manifestation of this disease and can be an extremely difficult management issue for clinicians.^1–3 At our institution, we have a large population of patients with HHT who are referred to the Otorhinolaryngology department for management of epistaxis. Accordingly, a larger proportion of our epistaxis embolization procedures are performed on patients with HHT compared with most practices. We describe our experience and technique for the endovascular treatment of epistaxis in patients with HHT and compare this to a group of patients treated endovascularly for epistaxis unrelated to HHT.     

Selective embolisation of posttraumatic intractable epistaxis

Idiopathic or trauma-related nose-bleeds can in rare cases be an intractable clinical picture in which normal conservative measures fail. Further therapeutic options that can be applied are surgical vascular ligature or selective endovascular occlusion. We report on a patient who developed hemodynamically relevant epistaxis due to splanchnocranial injuries after falling from his bicycle. Spiral-CT showed a fracture of the posterior nasal septum and of the inferior nasal concha. Despite anterior and posterior nasal tamponade, anemia occurred requiring transfusion and resulting in the interdisciplinary decision to perform transcatheter embolization. Via a trans femoral incision, a 5 F Vitek catheter was introduced into the maxillary artery, and a tracker system was then advanced through the catheter supraselectively and placed in the peripheral branches of the vascular system of the sphenopalatine artery. Selective DSA clearly showed the source of bleeding to be the area supplying the sphenopalatine artery. Following documentation of the localization of bleeding, a total of six (3/30 mm) complex heliacal mini-coils were inserted. After intravascular occlusion of the sphenopalatine artery, bleeding completely stopped within a few minutes. This shows that supraselective embolization is an easily conducted, effective and low-complication method for the definitive treatment of severe posttraumatic nosebleeds, even in emergency situations.     

严重创伤性鼻出血的急诊救治

目的　总结严重创伤性鼻出血的急诊救治经验。方法　对 1987～ 2 0 0 1年我院收治的严重创伤性鼻出血 336例进行回顾性分析。所有病例经鼻腔或前后鼻孔填塞止血或出血减少 ,对损伤血管较大或经反复填塞止血无效者 ,采用血管结扎或栓塞术等止血措施。结果　本组病例均达到止血目的 ,但仍因严重颅脑伤或颈、胸、腹等合并伤死亡 4 2例 (12 .5 % )。结论　创伤性鼻出血是一种复杂的危急重症 ,首诊医师应具备综合的急诊救治能力 ,各科需密切配合 ,以降低死亡率     

Microcatheter embolization of hemorrhages

Purpose To evaluate the efficacy of embolotherapy using microcatheters in patients with hemorrhage from various locations. Methods Among 29 patients there were 13 with severe epistaxis, 7 with gastrointestinal bleeding, 4 with hemorrhage in the kidney, 4 with bleeding in pelvic organs and 1 with bleeding in the shoulder region. In all cases, a Tracker-18 or Tracker-10 microcatheter was advanced coaxially through a 4.1 Fr guiding catheter in order to reach the bleeding site as distally as possible. Polyvinyl alcohol microparticles and/or platinum microcoils were used as embolic material. Results The bleeding was stopped in 90% (26 of 29) of cases. In 66% of cases the treatment was curative, in 7% preoperative, and in 17% palliative. There were 3 clinical failures. Conclusion Microcatheter embolization is an effective and safe means of managing different kinds of hemorrhage of various causes from a variety of sites.     

原发鼻腔恶性黑色素瘤11例临床分析

目的观察鼻腔原发性恶性黑色素瘤的临床特点,以帮助临床诊断和治疗。方法对1992—2007年12月间诊治的鼻腔原发性恶性黑色素瘤11例临床资料进行回顾性分析。结果 11例中,肿瘤多位于鼻腔外侧壁和鼻中隔,其中中鼻道5例,鼻中隔4例,中鼻甲1例,下鼻甲1例,肿瘤呈黑色或紫褐色8例,呈结节状或菜花状,淡红色表面光滑如息肉状3例;肿瘤触之易出血。结论本病临床少见,易误诊,应与鼻腔癌、血管瘤、鼻息肉相鉴别。对鼻腔发现的黑色或紫褐色肿物,触之易出血者可作该病的临床诊断,而不必取活检,以免促进肿瘤转移。     

鼻息肉的CT表现与诊断价值

目的：总结分析鼻息肉的CT表现特点,评价CT扫描对鼻息肉的诊断价值。方法：97例均行轴位及冠状位扫描,其中轴位24例,冠状位73例,全部病例经鼻内窥镜手术及病理证实。结果：97例中双侧发病72例,单侧发病25例。鼻息肉主要发生在筛窦及中鼻道,部分累及上颌窦及下鼻道,在CT断面上表现为鼻腔内息肉样肿块,均合并不同程度的鼻窦炎,冠状位CT扫描比轴位显示清楚。结论：鼻息肉在CT断面上有比较特征性的表现,诊断明确,冠状位能提供与功能鼻内窥镜手术方位一致的解剖层面,能清楚显示鼻道解剖结构和病变特点,对指导纤维内窥镜手术进路及防止并发症有重要指导意义。     

Partial resection of the middle turbinate at functional endoscopic sinus surgery

The middle turbinate is often carefully preserved at Functional Endoscopic Sinus Surgery (FESS). However there is no clear understanding of its importance and its presence may prevent good access to the middle meatus to the detriment of the surgical result. In addition its bulk may cause symptoms of nasal obstruction and prevent paranasal sinus drainage. Adhesions and stenosis have been reported at the middle meatus following its preservation. We undertook a prospective study of 50 consecutive patients all of whom underwent resection of the anterior half of the middle turbinate at the time of Functional Endoscopic Sinus Surgery. The patients were asked to complete a symptom score sheet before and ten weeks after surgery. The parameters considered were nasal obstruction, nasal congestion, discharge, facial pain and headache. Non parametric analysis of the results indicated a significant improvement in all patient symptom scores and no postoperative complications were noted. We conclude that partial resection of the middle turbinate is a useful modification of accepted endoscopic sinus surgery techniques.     

Endovascular Treatment of Epistaxis: Indications, Management, and Outcome

Objective

Epistaxis is a common clinical problem, and the majority of bleedings can be managed conservatively. However, due to extensive and sometimes life-threatening bleeding, further treatment, such as superselective embolization, may be required. We report our experience with endovascular treatment of life-threatening epistaxis.

Methods

All patients presenting with excessive epistaxis, which received endovascular treatment at a German tertiary care facility between January 2001 and December 2009, were retrospectively identified. Demographic data, etiology, origin and clinical relevance of bleeding, interventional approach, therapy-associated complications, and outcome were assessed.

Results

A total of 48 patients required 53 embolizations. Depending on the etiology of bleeding, patients were assigned to three groups: 1) idiopathic epistaxis (31/48), 2) traumatic or iatrogenic epistaxis (12/48), and 3) hereditary hemorrhagic telangiectasia (HHT) (5/48). Eleven of 48 patients required blood transfusions, and 9 of these 11 patients (82%) were termed clinically unstable. The sphenopalatine artery was embolized unilaterally in 10 of 53 (18.9%) and bilaterally in 41 of 53 (77.4%) procedures. During the same procedure, additional vessels were embolized in three patients (3/53; 5.7%). In 2 of 53(3.8%) cases, the internal carotid artery (ICA) was occluded. Long-term success rates of embolization were 29 of 31 (93.5%) for group 1 and 11 of 12 (91.7%) for group 2 patients. Embolization of patients with HHT offered at least a temporary relief in three of five (60%) cases. Two major complications (necrosis of nasal tip and transient hemiparesis) occurred after embolization.

Conclusions

Endovascular treatment proves to be effective for prolonged and life-threatening epistaxis. It is easily repeatable if the first procedure is not successful and offers a good risk?Cbenefit profile.