内窥镜鼻窦手术中出血问题的探讨

内窥镜鼻窦手术中出血的处理是个重要问题，为探讨出血的有关因素，对３４１例内窥镜双全筛切除和双侧全蝶筛切除标准术式的术中出血量及相关因素进行了统计分析。结果表明：术中出血的多少与手术次数、麻醉方式、术式、手术时间和手术熟练程度都有密切相关。多次手术的患者因瘢痕组织中血管失去弹性和病变中血管异常增生是导致术中出血较多的最重要因素。并根据临床实践经验，提出对出血进行处理的初步意见。     

成人和儿童功能性鼻内鼻窦手术

报道773例慢性或复发性鼻窦炎患者功能性界内鼻窦手术（FESS）。术时年龄14个月～sl岁，成人513例，儿童260例。术后随访＄一48个月（平均20个月）。病人在术前经多种方式治疗3～4周后无效，经CT证实鼻窦病变才作FESS。CT最常发现的是骨性鼻道复合一体阻塞的全鼻窦炎及14物的泡性鼻甲。术前使用血管收缩剂以改善能见度和减少术时出血。以4mm0“远窥镜检查筛窦和蝶窦、30“窥镜见于额隐窝和上颌窦、70”窥镜可为上颌窦提供极好的能见度。尽管年青病人解剖较小，使用4mm内窥镜手术仍易进行。术前用鼻内窥镜检查中隔、中甲、后鼻气道和腺…     

内窥镜鼻窦手术中出血问题的探讨

内窥镜鼻窦手术中出血的处理是个重要问题，为探讨出血的有关因素，对３４１例内窥镜双全筛切除和双侧全蝶筛切除标准术式的术中出血量及相关因素进行了统计分析。结果表明：术中出血的多少与手术次数、麻醉方式、术式、手术时间和手术熟练程度都有密切相关。多次手术的患者因瘢痕组织中血管失去弹性和病变中血管异常增生是导致术中出血较多的最重要因素。并根据临床实践经验，提出对出血进行处理的初步意见。     

鼻咽血管纤维瘤放疗后手术疗效评价

目的探讨鼻咽血管纤维瘤术前放疗对减少术中出血的影响.方法33例患者,21例行常规手术,12例术前两周行60Co放射5～7天,放射量10～20Gy,然后再行手术治疗.结果21例未放疗行常规手术者,术中出血250～3 600ml,平均1 100ml,术后复发4例.12例术前放疗者,术中出血200～800ml,平均450ml,术后无复发,术中出血较未放疗者显著减少(t=1.87,P＜0.01).结论放疗后切除鼻咽血管纤维瘤,有利于减少术中出血和术后复发.     

慢性鼻窦炎鼻息肉围手术前期处理对术中出血影响的观察

目的　探讨减少慢性鼻窦炎、鼻息肉内镜鼻窦手术中出血的方法。方法　通过对慢性鼻窦炎、鼻息肉患者进行围手术期术前处理 68例 ,并与未经围手术前期处理的同类手术 (30例 )进行比较。结果　术前处理组的手术有效率为 91 2 % ,术前未处理组的手术有效率为 80 % ,两者经统计学处理差异有显著性 (F =8 61 7,P =0 0 2 6) ;术前处理组术中出血量为 (53 2± 41 8)ml,术前未处理组为 (97 2± 59 0 )ml,两者经统计学处理差异有显著性 (F =2 7 946 ,P =0 0 0 2 )。结论　术前用药物控制慢性鼻窦炎、鼻息肉的炎症是减少内镜鼻窦手术出血的重要环节 ,而良好和足够时间的术中中鼻道血管收缩剂的应用、控制性低血压的应用、控制出血高危因素和减少术中损伤等对减少术中出血也非常有效     

儿童鼻窦内窥镜手术后鼻窦和面部的发育

功能性鼻窦内窥镜手术（FESS）用于治疗儿童慢性复发性昌窦炎已越来越普遍，许多儿童在鼻窦和面部发育完成前即接受该手术。为探讨FESS对儿童面顿发育的影响，进行动物实验和临床观察。实验动物为8只刚断奶的小猪，术前鼻窦照片排除先天性发育畸形和急性鼻窦疾病，全麻下随机选择一侧行FESS，包括筛漏斗切开、前筛窦切除、中鼻道造口，直视下用2．7mm30°镜开放前筛房，不干扰额隐窝、后组筛房及蝶窦气房。末手术侧作为对照。术后给予镇痛剂，肌注氯霉素琥珀酸钠25mg／kg，每日三次，用药3周。所有小猪术后经过平稳，出血少，无并发症…     

额窦手术并发视网膜中心动脉栓塞一例报告

额窦手术并发视网膜中心动脉栓塞导致失明在临床上极为少见。现报告一例。患者,男,56岁。反复发作鼻塞、脓涕、额部疼痛3年余。鼻窦摄片示左侧额窦炎。于局麻下行左侧额窦根治术,术前检查双眼视力均为1.5。术中以2％普鲁卡因加少量1％肾上腺素行筛前神经阻滞及骨膜下浸润麻醉。手术顺利,术中出血400ml左     

功能性内镜鼻窦手术并发症的临床分析

目的：探讨功能性内镜鼻窦手术(FESS)并发症的相关因素。方法：FESS手术l207例，在严格规定其手术适应证和手术范围的情况下，对并发症的发生率进行分析。结果：本组手术并发症36例，发生率为3．0％。眼睑淤斑、肿胀是本组最常见的并发症(18例)。术中出血15例，一过性复视l例，无原因发热2例。结论：FESS并发症发生率较低，且都比较轻微，没有严重并发症，这与手术切除局限，医生有较好的筛窦手术基础有关。     

鼻窦内镜手术术前术后的处理

目的 探讨鼻窦内镜术（FESS）术前术后处理对手术疗效的影响。方法 回顾101例鼻窦手术,从术前准备,麻醉方式,手术方式以及术后处理分析对术后疗效的影响。结果 101例患者手术疗效良好,其中3例经过复查恢复良好。结论 鼻窦内镜术的合适处理是提高手术成功率,减少并发症,提高治愈率的重要因素。     

41例鼻咽血管纤维瘤的诊断和治疗

目的 :探讨鼻咽血管纤维瘤的诊断和治疗。方法 :对 4 1例鼻咽血管纤维瘤采用不同进路进行手术治疗 ,其中腭进路 31例 ,面中部掀翻梨状孔进路 7例 ,扩大翼上颌裂进路 3例。结果 :术中平均出血量为 14 5 0ml,选择性瘤体供血动脉栓塞者出血量为 5 0 0～ 80 0ml。术后 1次复发 5例 ,2次复发 3例 ,术后复发时间为 0 .5～2年。结论 :术前应根据CT检查的结果认真制定手术进路 ;术前行血管造影及选择性血管栓塞 ,可明显减少术中出血量。此外 ,根据肿瘤的生长部位 ,在考虑面部美容效果的同时 ,术中应充分暴露术野 ,争取一次切除肿瘤     

慢性鼻-鼻窦炎在内镜手术后不填塞的可行性研究和适应证探讨

目的：探讨功能性内镜鼻窦手术（FESS）后不做填塞的安全性和可行性,并对适应证进行研究。方法：对74例慢性鼻窦炎患者（不填塞组）在FESS术后不进行填塞（保障措施包括：适当的病例选择,术前和术后抗炎,止血药物治疗,术中减少损伤,术后细致的防粘连处理）,并与填塞组（20例）进行对比分析。结果：不填塞组在FESS术后均无严重出血发生,术后渗血在2～6h内基本停止;在3个月的随访期内无术腔严重粘连发生。结论：采取适当的处理和预防措施,大多数FESS术后患者可不进行填塞,这可明显减轻患者的术后痛苦,降低治疗成本,也使患者对FESS治疗的依从性增加。     

难治性鼻出血患者出血部位各年龄段间的差异与特点

目的　探讨难治性鼻出血位点与年龄相关的分布特点及规律。方法　回顾性分析住院治疗的149例难治性鼻出血患者的临床资料,按年龄分为青年组（≤39岁）、中年组（40～59岁）、老年组（≥60岁）,分析其出血部位的特点及规律。结果　149例患者中,男性110例,女性39例;年龄 18～87岁,平均（53±14）岁;青年组36例,中年组52例,老年组61例。149例患者均行鼻内镜下鼻腔探查止血术。其中明确出血部位后行电凝止血或微填塞145例,并记录出血部位;未明确出血部位患者4例。三组患者最常见出血部位依次为：青年组：下鼻道穹窿22例（61%）,中鼻甲后段13例（36.1%）,嗅裂区中隔面1例（2.7%）;中年组：下鼻道穹窿23例（44.2%）,中鼻甲后段10例（19.2%）,嗅裂区中隔面17例（32.7%）;老年组：嗅裂区中隔面37例（60.6%）,中鼻甲后段15例（24.6%）,下鼻道穹窿7例（11.5%）。结论  难治性鼻出血患者中,青、中年患者出血部位以蝶腭动脉分支出血居多;老年患者出血部位以筛前动脉、筛后动脉分支出血居多。随年龄增长蝶腭动脉分支出血比例减少,筛前动脉、筛后动脉分支出血机会增加。     

Endoscopic ligation of anterior ethmoidal artery in treatment of epistaxis

Arterial ligation of the anterior ethmoidal artery may be required in cases of persistent epistaxis and conventional techniques involving open surgery carry a recognized morbidity. We describe an endoscopic, intranasal technique for ligation of the anterior ethmoidal artery. This technique was performed in a patient who had a severe epistaxis following nasal trauma. Her epistaxis persisted in spite of anterior and posterior nasal packing. Endoscopy showed the bleeding to originate high and lateral to the middle turbinate. Endoscopic exploration defined the frayed end of the anterior ethmoidal artery. A ligaclip was placed with immediate and persistent arrest of her epistaxis. No further nasal packs or treatment were required.     

Clinical analysis of delayed epistaxis following endoscopic sinus surgery

ObjectiveTo investigate the clinical characteristics and treatment methods associated with delayed epistaxis following endoscopic sinus surgery.MethodsThe clinical data of 46 patients with delayed epistaxis following endoscopic sinus surgery were retrospectively analyzed. To explore the clinical features, pathogenesis, and treatment plan for delayed epistaxis, the postoperative bleeding time, bleeding inducements, systemic complications, surgical approach, the hemorrhage locations and responsible vessels, and treatment methods were analyzed.ResultsThe average bleeding time was 16.34 ± 9.05 days after the operation, and 76.6% of the cases occurred 6–20 days after the operation. Sphenopalatal artery hemorrhage accounted for 69.6% (32/46), the most common of which was a posterior nasal septal artery hemorrhage (17/32). A total of 45 patients received endoscopic low-temperature plasma hemostasis following ineffective nasal packing, and no rebleeding in the ipsilateral nasal cavity was observed during the postoperative follow-up for 3 to 6 months.ConclusionsThe peak of hemorrhaging in delayed epistaxis following endoscopic sinus surgery occurred at 6–20 days post-operatively. Bleeding of the posterior nasal septal artery from the sphenopalatine artery was the most common. Surgical methods were closely related to delayed postoperative hemorrhage. Treatment with low temperature plasma hemostasis under nasal endoscope was found to be effective.     

Intranasal microsurgical procedure in epistaxis of the cribriform plate and further interventions using hypotension

For the past 25 years we have been able to control severe epistaxis in all patients by an intranasal procedure. If the source of bleeding in patients with epistaxis from the upper part of the nose cannot be seen during the acute phase, a combined anterior-posterior nasal pack is inserted and left in place for three days. Should bleeding persist or recur after removal of the packing we resect the superior nasal septum to expose the bleeding point in the anterior area of the cribriform plate. Cauterization at this site is not safe because of the risk of CSF rhinorrhea, and it is not always successful, as the main blood supply to the ethmoidal arteries stems from the internal carotid artery. Cauterization of the anterior or posterior ethmoidal arteries within the bony canal of the ethmoidal sinus (after partial ethmoidectomy) is always successful. Ligation or embolization of the carotid arteries is indicated only for tumour patients. Intranasal ethmoidal microsurgery requires much practice and preliminary experience on at least 50 cadavers. In 25 years with an annual load of about 180 ethmoidal sinus surgery cases we have never had serious complications such as cerebrospinal fluid rhinorrhea or persisting optical disturbances in more than 4,000 operations. During 1984 at the Krupp Hospital we used the intranasal microsurgical approach for all patients with septal, ethmoidal sinus and lacrimal duct pathology, for 98% of cases requiring maxillary sinus procedures and for 82% of patients with frontal sinus problems.(ABSTRACT TRUNCATED AT 250 WORDS)     

Surgical anatomy of the sphenopalatine artery in lateral nasal wall

OBJECTIVE: We investigated the surgical anatomy of the sphenopalatine artery. First, the location of the sphenopalatine foramen on the lateral nasal wall and the pattern of the main branches of the sphenopalatine artery from the sphenopalatine artery were studied. Second, the course of the posterior lateral nasal artery with respect to the posterior wall of the maxillary sinus, the perpendicular plate of the palatine bone, and the pattern of distribution of its branches on the fontanelle was determined. Third, the distribution pattern on the inferior turbinate was analyzed. STUDY DESIGN: Fifty midsagittal sections of randomly selected Korean adult cadaver heads with intact sphenoid sinus and surrounding structures were used in the study. METHODS: The mucosa on the sphenopalatine foramen and its surrounding mucosa were removed with a microscissors, a fine forceps, and a pick to expose the sphenopalatine artery under an operating microscope (original magnification x6). RESULTS: The feeding vessels of the superior turbinate were from the septal artery in 36 cases (72%). The feeding vessels to the middle turbinate branch originated from the proximal portion of the posterior lateral nasal artery just after exiting the sphenopalatine foramen in 44 cases (88%). Some portion of the posterior lateral nasal artery ran anterior to the posterior wall of the maxillary sinus in 38%. The major feeding arteries to the fontanelle were from the inferior turbinate branch in 25 cases (50%). In most cases, the inferior turbinate branch was the end artery of the posterior lateral nasal artery (98%). CONCLUSIONS: The study provides detailed information concerning the sphenopalatine artery, which we hope will help explain the arterial bleeding that may occur during ethmoidectomy, middle meatal antrostomy, conchotomy, and endoscopic ligation of the sphenopalatine artery.     

筛动脉眶内段及窦内段的应用解剖研究

目的：研究筛动脉的走行规律及局部位置关系,为筛窦手术和视神经管减压术提供参考。方法：采用显微解剖学技术对６０ 侧成人筛动脉眶内段和窦内段进行观察和测量。结果：筛前动脉眶内段长（５．１６±１．２４）ｍ ｍ ,管径为（０．５６±０．１７）ｍ ｍ ;筛后动脉眶内段长（９．０８±２．２９）ｍ ｍ ,管径为（０．３７±０．１４）ｍ ｍ 。筛动脉的周围有致密结缔组织构成的筋膜鞘,该鞘包绕与之并行的筛神经和筛静脉,筋膜鞘在筛动脉窦内段亦存在。筛动脉窦内行程有三种类型：走在骨管内;走在筛房顶壁和筛粘膜之间;部分走在骨管内。结论：在筛窦手术或视神经管减压术中,正确寻找和处理筛动脉有重要意义     

New guidelines for endoscopic localization of the anterior ethmoidal artery: a cadaveric study

OBJECTIVES: To determine objective data to improve the methods of identification of the anterior ethmoidal artery during endoscopic dissection. STUDY DESIGN: Cadaveric dissection of adult human heads. METHODS: A 0 degrees, 4-mm rigid endoscope was used to guide uncinectomy and frontoethmoidectomy. The location of the anterior ethmoidal artery was first determined visually and then confirmed by passing a needle through the anterior ethmoidal foramen from the orbit into the nose in all cases. The distances were endoscopically measured using a simple ruler between two nasal landmarks and the anterior ethmoidal artery. RESULTS: Fifty-six nasal fossae in 28 cadavers were dissected endoscopically. The median distance between the artery and the "axilla" formed by the anterior attachment of the middle turbinate to the lateral nasal wall was 20 mm (range, 17-25 mm), irrespective of the side. The measurement differed by less than 2 mm between the sides in the same individual. The median distance between the artery and the "axilla" formed by the medial and lateral crura of the lower lateral cartilage (superomedial edge of the nostril) was 62 mm (range, 55-75 mm) for both sides. The artery was found to be in direct alignment with the two "axillae" formed by the middle turbinate and the nostril edge. CONCLUSIONS: The distance between the ethmoidal artery and the axilla of the middle turbinate showed the least intraindividual and interindividual variations. The tip of the endoscope (or the ruler) points directly at the anterior ethmoidal artery in the fovea ethmoidalis when its edge is aligned with the two nasal landmarks. These simple guidelines can aid the identification of the artery in endoscopic frontoethmoidectomy.     

The clinical value of the novel cauterization procedure for the inferior turbinate artery during turbinate surgery

The objective of the study was to evaluate the efficacy and the safety of the novel cauterization procedure of the inferior turbinate artery, which may be performed with any kind of inferior turbinate procedures in reducing the intra and the post-operative bleeding in partial inferior turbinectomy. A prospective controlled study was conducted in a referral center. Sixty patients (38M, 22F) who underwent partial turbinectomy were included. In 20 patients, partial turbinectomy was performed with the cauterization in one nasal cavity and the other one without it. The remaining 40 patients were divided into two groups which comprised cauterization positive and negative patients and are assessed in terms of post-operative bleeding. The area of the cauterization was 1 cm² field which is 1 cm anterior to the posterior attachment of the inferior turbinate on the lateral nasal wall, very close to the inferior turbinate, where the pulsating vessel is most commonly seen. Mean operation time, mean intra-operative blood loss and post-operative bleeding incidence are the main outcome measures. Post-operative bleeding was seen in three patients (15%) in the cauterization negative group. No patient had post-operative bleeding in the cauterization positive group. Mean operation time and mean intra-operative bleeding amount were significantly lower in the cauterization positive side. Cauterization of the inferior turbinate artery on the lateral nasal wall is a safe and effective method which may also be performed with any kind of inferior turbinate procedures to reduce both the operation time and intra and post-operative bleeding.     

Bilateral nasal vascular responses to unilateral sympathetic stimulation

Unilateral preganglionic cervical sympathetic stimulation in the anaesthetized cat evoked vasoconstriction in both nasal cavities, dependent on stimulation frequency. Vasoconstriction in the contralateral cavity was 15--20% of that of the stimulated side. Similar findings were obtained on unilateral Vidian nerve stimulation. Vasoconstriction evoked in the sympathectomized nasal cavity by stimulating the opposite cervical chain was reduced but not abolished by sectioning the posterior nasal and ethmoidal nerves of the stimulated side. It is suggested that vasoconstrictor fibres reach the opposite cavity either in these nerves or by way of blood vessels, but more likely that sympathetic fibres from these pathways innervate blood vessels which supply both nasal cavities.