A randomised clinical trial of antiseptic nasal carrier cream and silver nitrate cautery in the treatment of recurrent anterior epistaxis

Sixty-four consecutive patients with a history of recurrent epistaxis were randomly assigned in the outpatient clinic to receive treatment with either Naseptin antiseptic nasal carrier cream alone (Group A) or a combination of Naseptin cream and silver nitrate cautery (Group B). Results were available on 50 patients, 22 in Group A and 28 in Group B. Twenty patients (91%) in Group A and 25 patients (89%) in Group B demonstrated improvement in their symptoms. There was no statistically significant difference in outcome between the two treatment arms (P = 0.7569). On comparing the different age groups (under and over 16 years) in the two treatment arms, once again there was no statistically significant difference in the treatment outcome (P = 1.000). In conclusion, silver nitrate cautery offers no added advantage to the management of simple epistaxis in both children and adults.     

鼻内镜下高渗葡萄糖黏膜下注射加局部填塞治疗下鼻道出血

鼻出血是鼻科常见病、多发病,对于出血不剧、出血点位于前段的鼻出血,处理较为容易,但对于前鼻镜下未能窥及出血点或出血较猛者,传统的前后鼻孔填塞效果往往欠满意,部分患者常反复发作。血管栓塞术由于对设备要求高、操作复杂、费     

鼻内镜下治疗顽固性鼻出血64例临床分析

顽同性鼻出血患者的出血点多位于鼻腔后端。采用传统的鼻腔填塞止血法治疗顽同性鼻出血须行后鼻孔栓塞,该方法易损伤鼻腔黏膜,常不能彻底止血,多需反复填塞,易导致鼻腔感染或其他并发症的发生,给患者带来较大痛苦。我科2007-01-2012-12应用鼻内镜对鼻腔填塞止血失败的64例顽同性鼻出血患者进行检查并止血治疗,术后应用钠吸绵填塞,疗效满意,现报告如下。     

鼻内镜下微波治疗顽固性鼻出血

目的 探讨鼻内镜下微波治疗顽固性鼻出血的应用价值及适应证。方法 回顾分析45例顽固性鼻出血患者鼻内镜下微波治疗的临床资料。结果 随访6个月～2年，治愈39例，有效4例，无效2例，总有效率95．6％。结论 鼻内镜下微波治疗顽固性鼻出血方法简单、有效，患者痛苦力，无并发症，值得临床推广。     

鼻内镜鼻腔扩容手术在难治性鼻出血治疗中的应用

目的 探讨难治性鼻出血的治疗方法。方法 对 28例难治性鼻出血患者先行鼻内镜鼻腔扩容手术,解除鼻腔结构异常,再寻找出血点,电凝止血。结果 25例无复发,无鼻腔粘连等并发症;2例术后2周复查发现鼻中隔与下鼻甲轻度粘连,行粘连松解,随访6个月未见再次粘连,未见出血复发;1例出院后1个月出血复发,再次手术后未再出血,随访6月未见复发。28例均无鼻腔干燥、头痛等并发症。结论 鼻内镜鼻腔扩容手术治疗难治性鼻出血效果可靠。     

Surgical treatment of severe epistaxis: an eleven-year experience

Epistaxis is one of the most prevalent emergencies in ENT practice, and its surgical treatment is part of the routine at services for emergency care, especially in cases refractory to clinical procedures.ObjectiveTo analyze the profile of patients and the results this service has had in the surgical treatment of epistaxis for the last 11 years.MethodData from 98 patients submitted to surgery for epistaxis between 2000 and 2011 were analyzed retrospectively.ResultsMost in the sample were males, and mean age was around 46 years. Hypertension was identified in 58% of patients, and most events occurred during fall and winter. The re-bleeding rate was 13.27%.ConclusionThis study concluded that the surgical treatment for epistaxis, when indicated, had good success rates and low incidence of complications. In our service, it remains as the gold-standard procedure for nosebleeds refractory to initial management measures.     

鼻内镜辅助治疗鼻出血的临床报告

2006—01—2011—12笔者在鼻内镜辅助下应用双极电凝、微波凝固、局部填塞等措施综合治疗鼻出血,效果良好,报告如下。     

Recurrent epistaxis and nasal septal deviation in young adults

Epistaxis is common in young adults but the aetiology is unknown in many cases. To investigate the possibility that septal deviations are associated with epistaxis, 54 servicement with recurrent epistaxis were compared with 46 controls. The epistaxis group were significantly more likely to have a history of nasal trauma (P=0.008) and radiologically-proven nasal fracture (P=0.002); on clinical examination, they were more likely to have a deviated septum (P<0.00001), maxillary spur (P=0.00004) and nasal obstruction (P=0.011); they were also more likely to have radiological evidence of a deviated septum (P=0.020). Those patients able to locate their epistaxis to one side tended to do so to the side of their septal deviation. This study supports the hypothesis that septal deviation is associated with epistaxis.     

Dominant maxillary artery as a cause of failure in maxillary artery ligation for posterior epistaxis

Ligation of the maxillary artery is a logical and effective method for the arrest of severe uncontrollable posterior epistaxis. The failure rates for arrest of haemorrhage are given in the literature as 10–13%. In our centre, over the last 9 years, 23 patients have undergone maxillary artery ligation to control epistaxis without a failure. Bilateral maxillary artery ligation was carried out whenever the maxillary artery of the bleeding side was found to be of small diameter. To investigate whether there is an asymmetry in the size of the maxillary arteries we performed 13 cadaveric dissections. In 6 of the cadavers one maxillary artery was significantly larger than the other. This fact has hitherto not been observed by otolaryngologists or anatomists. Failure to arrest haemorrhage may have resulted from ligation of the non-dominant maxillary artery with consequent opening of cross-anastamoses from the dominant side.     

The combined use of two RapidRhino packs instead of anteroposterior packing for the control of severe epistaxis

Epistaxis is a common ear, nose, and throat emergency, and severe cases are traditionally controlled by the placement of anteroposterior nasal packing. In this article, a way of controlling severe epistaxis with the combination of two RapidRhino packs is described. Although not always successful, it is a technique that in the majority of patients can control severe bleeding faster, easier, with decreased pain, and increased patient comfort, compared to the traditional anteroposterior nasal packing.     

蝶腭动脉结扎术治疗难治性鼻出血的研究进展

内镜下行蝶腭动脉结扎术,对保守治疗无效的鼻后端出血是有效且安全的治疗方法。本文对蝶腭动脉结扎术的产生及发展、解剖学基础、手术操作过程、适应证、有效性及并发症等方面进行综述,深入理解蝶腭动脉结扎术治疗难治性鼻出血的解剖基础及临床实践的意义。蝶腭动脉结扎术治疗难治性鼻出血,其理论支持充分,解剖标志相对固定,临床操作简单,效果可靠。可在临床广泛应用。     

Endoscopic intraoperative control of epistaxis in nasal surgery

Objective

: Epistaxis represents a dangerous post-operative complication of nasal surgery. The advances of endoscopic procedures have also brought along the possibility of a surgical solution of nasal bleeding. These procedures include endoscopic cautery of the bleeding points, and more difficult techniques of endoscopic ligation of the sphenopalatine artery or the anterior ethmoidal artery. These surgical methods permit avoiding nasal packing, a very annoying procedure for the patient. This study aims to evaluate the advantages of this approach at the end of a nasal surgery to prevent routine nasal packing.

Method

: 133 subjects were operated on by the same surgeon in the Otorhinolaringology Department of University of Foggia (Italy) from March 2006 to March 2007. 17 (12.8%) patients were submitted to septoplasty, 42 (31.5%) to turbinoplasty (in 22 accompanied by septoplasty) and 74 (55.6%) to endoscopic sinus surgery (ESS) for nasal polyposis or nasal tumors.

Results

: Only 16 cases (12%) underwent nasal packing, while in the remaining 117 (88%) endoscopic control of bleeding permitted avoiding packing. In 53 (39.8%) patients only an endoscopic cauterization of bleeding points was performed; in 29 (21.8%) cases a sphenopalatine artery ligation was necessary. Only 2 subjects (1.5%) underwent anterior ethmoidal artery ligation. In the remaining 34 (25.5%) patients no procedure was necessary, due to the apparently scarce bleeding in the endoscopic vision at the end of surgery. In this group of non-packed patients, only 8 (6.8%) needed a post-operative tamponade while in the group of packed patients, 2 (12.5%) cases had a re-bleeding and a revisional surgery was necessary.

Conclusion

: Intra-operative precautional packing is therefore not justified during nasal surgery because of the small percentage of post-operative epistaxis. Intra-operative control of bleeding allowed nasal packing to be avoided in a large percentage of cases.     

鼻内镜术后迟发性鼻出血的原因和治疗

目的:探讨鼻内镜术后迟发性鼻出血的原因和治疗方案。方法:回顾性分析因鼻内镜术后鼻出血入院的11例患者,对其出血诱因、鼻内镜术式、出血时间、出血部位和治疗过程进行比较和总结,寻找规律,探讨内在的机制。结果:11例患者中,出血诱因不同,部位不同,经不同的治疗均达到了止血的目的。结论:鼻内镜术后迟发性鼻出血不容忽视,有一定的诱因,鼻内镜术式可能与出血部位有关,其治疗以鼻内镜下探查出血点后,给予相应治疗,效果较好。必要时行血管栓塞术。     

鼻内镜下电凝联合微填塞治疗难治性鼻出血

难治性鼻出血多指前鼻镜检查不能明确出血部位,用传统的前后鼻孔填塞不能控制的鼻出血[1].我科2010年12月至2012年12月对108例难治性鼻出血患者采用鼻内镜下电凝止血联合微填塞为主的综合治疗措施,效果良好,现报告如下. 1 资料与方法 1.1 一般资料108例患者中,男68例,女40例;22 ～ 89岁,均为单侧鼻出血,前鼻镜下未能窥及出血点.其中明确的鼻出血原因为:高血压46例,服用阿司匹林引起14例,鼻腔小血管瘤12例,鼻中隔棘突6例,鼻腔鼻窦出血坏死性息肉4例,急性鼻炎2例,鼻腔干燥引起14例,原因不明10例.出血部位:下鼻道47例,鼻中隔后部34例,嗅裂区鼻顶12例,中鼻道8例,下鼻甲内侧面3例,中鼻甲2例,蝶腭动脉孔处2例.本组资料不包括外伤性鼻出血、恶性肿瘤及血液疾病所致鼻出血.     

Bilateral simultaneous nasal septal cauterization in children with recurrent epistaxis

Objective

To investigate the feasibility, effectiveness and complications of bilateral simultaneous silver nitrate cauterization for anterior nasal septal epistaxis in otherwise healthy children.

Methods

Prospective study in a tertiary referral otorhinolaryngology department.Thirty-seven children with anterior epistaxis between the ages of 5-16 years were included in the study. The patients who had varicose vessels or network of small vessels in the Little's area had simultaneous bilateral silver nitrate cauterization.

Results

Complete or near-complete epistaxis control was obtained in 76% of the patients after the first cauterization, and in 86% of the patients after the second cauterization in a mean follow-up period of 8 months. Partial success was obtained in five patients. The crusting in the cauterization area was healed late in six patients. Septal perforation, tattooing, or mucocutaneous/allergic reactions were not observed in any of the patients.

Conclusions

Bilateral silver nitrate cauterization is an effective, feasible, low-cost and preferable treatment method in childhood epistaxis when it is applied in an appropriate concentration and at an appropriate duration in a healthy mucosal environment.     

4种方法治疗鼻Little区出血的疗效比较

目的：比较ＣＯ２激光等４种方法治疗鼻Ｌｉｔｔｌｅ出血的疗效。方法：对８５１例鼻Ｌｉｔｔｌｅ区出血患者分别采用硬化剂粘膜下注射、冷冻、ＣＯ２激光和化学烧灼４种方法治疗。结果：硬化剂治疗有效率为９２．４％;ＣＯ２激光治疗为７５．８％;冷冻治疗为７６．４％;化学烧灼为７３．８％。结论：鼻Ｌｉｔｔｌｅ区出血可首选硬化剂粘膜下注射治疗,其疗效虽优于其他３种治疗方法（Ｐ〈０．０５）,但亦应根据具体病情选出其他