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。     

外伤性颌内动脉损伤引起严重鼻出血的诊断及治疗探讨(附12例报告)

目的 探讨颌面部外伤引起的颌内动脉损伤致严重鼻出血的发病机制、出血特点、诊断及治疗方法。 方法 回顾分析经手术或数字减影血管造影(DSA)证实颌面外伤引起的颌内动脉损伤致严重鼻出血12例的病例资料。 结果 6例行鼻内镜检查,见鼻腔外侧壁黏膜下有搏动出血,迅速改行柯-陆氏入路找到出血责任血管并止血,其中4例同期行上颌骨、颧骨骨折复位、钛板坚强内固定术。6例行DSA确诊并行血管栓塞治疗。 结论 对颌面外伤后反复鼻腔大出血患者,应考虑颌内动脉损伤,应尽早行鼻内镜检查止血和/或DSA检查并行栓塞治疗。若行鼻内镜检查止血过程中来不及栓塞治疗,可立即经柯-陆氏入路找到出血责任血管行血管结扎或电凝,也可填塞碘仿纱条止血。止血后请口腔颌面外科同期行颌面骨折复位坚强内固定术。     

数字减影血管造影在严重鼻衄中的应用

本文对我院1994年来,采用DSA血管栓塞治疗的13例严重鼻衄进行了分析。其中11例栓塞颌内动脉后止血;1例去除前、后鼻孔填塞物仍出血,再次栓塞面动脉后止血;仅1例插管失败。栓塞止血有效率为92．3％。无严重并发症发生。DSA具有实时显像、轨迹减影透视等功能。在严重鼻衄治疗中,有简单、有效、安全等优点。文章讨论了DSA的操作要点、并发症预防措施。认为DSA血管栓塞可作为治疗严重鼻衄常现方法。     

后鼻孔出血栓塞治疗:31例分析

报道31例顽固性后鼻孔出血的柱塞治疗。3响患者，虽然经前后鼻孔填塞或前后鼻孔填塞并结扎筛前动脉（8例），筛后动脉（6例）或颌内动脉（5例），但仍出血不止。采取诊．断性血管造影术和颌内动脉栓塞米。患者于清醒状态下，经股动脉穿刺插管（28例）或颈动脉穿刺插管（3例），插管后行颌内动脉选择性血管造影照相，并经导管注入可吸收明胶海绵（29例）或聚乙烯酸泡沫（2例）。结果发现，2例颌内动泳是血管瘤样畸形，2例有活动性出血（外渗），l例为皿供丰富的转移性肿瘤。经颌内动脉栓塞，22例（71畅）后鼻孔出血治愈，其中2例于11个月内再…     

鼻出血的治疗(附79例病例分析)

目的：总结鼻出血的治疗经验，分析治疗中可能存在的问题，探讨各种治疗措施在处理鼻出血中的意义。方法：对近6年来住院治疗的鼻出血病人79例进行回顾分析。结果：79例均治愈，治疗手段包括前后鼻孔填塞、内镜下激光烧灼、颈外动脉和/或筛前动脉结扎、经上颌窦颌内动脉结扎或数字减影血管造影颌内动脉栓塞等。结论：治疗鼻出血的关键是找淮出血部位及明确出血原因，并根据病人实际情况采取有效止血措施。     

成人自发性难治性鼻出血的诊治分析CSCD

目的探讨成人自发性难治性鼻出血的临床特点、治疗方法及疗效。方法回顾分析2003年5月~2018年11月我院急诊收治住院的成人自发性难治性鼻出血患者共429例,经鼻腔填塞止血、鼻内镜下电凝止血、超选择性颈外动脉栓塞等多种治疗措施结合应用,取得良好效果。结果经单次单一治疗措施成功止血病例332例(77.4%),经2次及2次以上或结合2种及2种以上治疗措施后成功止血97例(22.6%)。其中经鼻腔填塞成功止血80例,经鼻内镜下电凝成功止血262例,经超选择性颈外动脉分支栓塞止血89例。结论鼻内镜下电凝止血仍是治疗鼻出血的首选方法,但超选择性动脉栓塞治疗难治性鼻出血止血迅速,效果肯定,复发率低,为难治性鼻出血的治愈提供了一种安全有效的方法。     

鼻衄、鼻咽纤维血管瘤及软腭血管瘤的介入治疗

应用介入性放射技术经导管超选择性动脉栓塞治疗严重界出血、鼻咽纤维血管瘤、腰部血管瘤各1例，报告如下。例1男，25岁。钢管重击鼻部后左鼻腔反复凶猛出血，行前后鼻孔填塞、立止血、输血等治疗无效，出血总量达2200ml。血管造影示左颌内动脉分支及其与咽升动脉吻合处造影剂外溢，于明胶海绵微粒栓塞，出血止（图1）。两天后右鼻腔出血，一夜出血量800ml，再行右颌内动脉栓塞。此后间断少量出血，经前鼻孔填塞3天痊愈，鼻部检查未见异常，随访1年未再出血。例2男，52岁。右软跨血管瘤20年，硬化剂局部注射10余次后复发，查见右软蹈及扁桃…     

成人自发性难治性鼻出血的诊治分析

目的　探讨成人自发性难治性鼻出血的临床特点、治疗方法及疗效。方法　回顾分析2003年5月～2018年11月我院急诊收治住院的成人自发性难治性鼻出血患者共429例,经鼻腔填塞止血、鼻内镜下电凝止血、超选择性颈外动脉栓塞等多种治疗措施结合应用,取得良好效果。结果  经单次单一治疗措施成功止血病例332例（77.4%）,经2次及2次以上或结合2种及2种以上治疗措施后成功止血97例（22.6%）。其中经鼻腔填塞成功止血80例,经鼻内镜下电凝成功止血262例,经超选择性颈外动脉分支栓塞止血89例。结论　鼻内镜下电凝止血仍是治疗鼻出血的首选方法,但超选择性动脉栓塞治疗难治性鼻出血止血迅速,效果肯定,复发率低,为难治性鼻出血的治愈提供了一种安全有效的方法。     

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。     

鼻腔后部出血选译性颌内动脉栓塞术

作者以选择性颌内动脉栓塞术治疗难制止的鼻腔后部出血5例:其中3例按Seldinger 氏法自右股动脉插管,管径6.5F;高龄者2例,70～75岁,考虑有动脉硬化而自颈总动脉插管,管径5F。均先做出血侧颈外动脉造影,然后将导管送入颌内动脉。在透视下将小片明胶海绵约1×2×5mm 混于造影剂中,作颌内动脉造影的同时将之栓塞。有出血性素质、造影剂过敏、严重高血压或肾功能不良者禁用。本组5例原因不明特发性鼻出血经血管栓塞后观察2～9个月,无一例再出血。本法无需外科手术,颈外动脉造影尚可发现异常血管找到出血点。上颌窦术后、上颌窦发育不良者作颌内动脉结扎有困难,采用本法则简便有效。但将导管插入颌内动脉需专门训练。合并症有面神经部分麻痹、牙关紧闭、面部疼痛     

眼动脉及其相关动脉的应用解剖学研究

目的：探讨介入栓塞上颌动脉治疗鼻出血引发单眼失明发生的原因,为防止类似严重并发症的发生提供相关血管的解剖学基础。方法：在100侧人脑标本上观察眼动脉、视网膜中央动脉和异常眼动脉的起始走行和出现率,以及眼动脉和上颌动脉的交通支路径。结果：眼动脉95％发自颈内动脉前床突上段,5％发自上颌动脉的分支脑膜中动脉,眼动脉和脑膜中动脉之间有交通支存在的占80％,视网膜中央动脉100％发自眼动脉。结论：上颌动脉栓塞导致单眼失明的原因是眼动脉异常起始脑膜中动脉或脱落的阻塞剂栓子或血栓经上颌动脉的脑膜中动脉与眼动脉交通支阻塞眼动脉或视网膜中央动脉所致。提示治疗难治性鼻出血栓塞上颌动脉时导管应置入上颌动脉末端,以避开脑膜中动脉;术后一旦有视物不清,4h内进行溶栓,视力可望恢复。     

Superselective angiographic embolization for intractable epistaxis

CONCLUSIONS: Routine embolization of the ipsilateral facial artery (FA) is effective because of the high success rate. The use of different embolic materials for the internal maxillary artery (IMA) and the FA was considered safe because of the absence of major complications. OBJECTIVE: To evaluate outcomes of routine embolization of the FA as well as the IMA ipsilateral to the bleeding site for intractable epistaxis, and outcomes using different embolic materials for the FA and the IMA. PATIENTS AND METHODS: Twenty-two patients with intractable epistaxis who underwent superselective embolization were retrospectively analyzed with a mean follow-up of 7 months. The FA and the IMA ipsilateral to the bleeding site were embolized. Two embolic materials, gelatin sponge and microcoils, were used for the IMA and the FA, respectively. RESULTS: The short-term success rate within the first 7 days was 77.3% (17/22). The long-term success rate was 95.5% (21/22). There were no major complications in 22 cases. Minor complications occurred in 13 cases (59%). These minor complications usually did not last more than a week and most resolved within a day.     

Treatment of severe epistaxis by superselective embolization: a review of 22 cases

OBJECTIVES: Epistaxis represents one of the most common ENT emergencies. In this paper, the authors report their experience in treating some cases of severe epistaxis by super-selective embolization of the afferent vessels of the nasal fossae. PATIENTS AND METHODS: A retrospective study of 22 patients with severe recurrent epistaxis (1 anterior and 21 posterior). All patients had been treated unsuccessfully with repeated anteroposterior nasal packing, and presented significant secondary anaemia. Selective embolization procedures were performed under local anaesthesia. An arterial introducer is inserted into the femoral artery -generally the right one- and diagnosis as well as treatment are performed with the same guide catheter. In all cases, the terminal branches of the facial artery and of the internal maxillary artery on the side on which the haemorrhage occurred were embolized. Moreover the contralateral internal maxillary artery was always embolized as well, in order to prevent immediate recurrence of hypervascularisation of the mucosa through anastomotic paths. RESULTS: In all patients, complete devascularisation was achieved in the areas of the embolized arteries at the nasal mucous membranes, arresting the epistaxis. None of the cases experienced complications attributable to treatment. DISCUSSION AND CONCLUSION: Superselective arteriography with embolization can be considered as the method of choice in treating severe epistaxis because it can be performed under local anaesthesia and can easily be repeated if the first procedure is not successful. Moreover, it is at least as effective as ligation of the internal maxillary artery, if not more so, but it has a significantly lower complication rate which is destined to fall as the quality of the materials being used continues to improve.     

介入栓塞加局部注射硬化剂治疗头颈部巨大血管瘤

目的：探讨采用动脉栓塞疗法加局部注射硬化剂治疗头颈部巨大血管瘤的疗效。方法：3例患者均先经DSA技术,对与血管瘤有关的颈外动脉分支进行介入栓塞治疗。术后每隔7～14d用硬化剂行瘤体内注射。结果：栓塞术加局部注射硬化剂后瘤体明显缩小至基本消失。栓塞区有轻微疼痛、肿胀,经对症处理后消失。未发生误栓其他器官及大面积组织坏死等并发症。随访6个月～2年未见复发。结论：DSA下动脉栓塞治疗对有明确责任动脉的血管瘤有良好的临床疗效;栓塞后瘤体内注射硬化剂可减少复发。     

Metastatic Cervical Lymph Nodes from Urogenital Tract Carcinoma: A Diagnostic and Therapeutic Challenge

Conclusions. Routine embolization of the ipsilateral facial artery (FA) is effective because of the high success rate. The use of different embolic materials for the internal maxillary artery (IMA) and the FA was considered safe because of the absence of major complications. Objective. To evaluate outcomes of routine embolization of the FA as well as the IMA ipsilateral to the bleeding site for intractable epistaxis, and outcomes using different embolic materials for the FA and the IMA. Patients and methods. Twenty-two patients with intractable epistaxis who underwent superselective embolization were retrospectively analyzed with a mean follow-up of 7 months. The FA and the IMA ipsilateral to the bleeding site were embolized. Two embolic materials, gelatin sponge and microcoils, were used for the IMA and the FA, respectively. Results. The short-term success rate within the first 7 days was 77.3% (17/22). The long-term success rate was 95.5% (21/22). There were no major complications in 22 cases. Minor complications occurred in 13 cases (59%). These minor complications usually did not last more than a week and most resolved within a day.     

Percutaneous embolization for cervicofacial neoplasms and hemorrhages

OBJECTIVE: To retrospectively assess the effectiveness of percutaneous embolization for curative, preoperative or palliative management of hypervascular neoplasms, vascular malformations and bleedings of the head and neck area. METHODS: A retrospective 8-year analysis of outcomes in 85 patients undergoing preoperative embolization for tumors or vascular lesions of the head and neck or embolization for refractory tumor bleeding and epistaxis at our hospitals was performed by reviewing case records. Outcome of the preoperatively embolized patients was defined as successful if intraoperative bleeding was <500 ml and/or postinterventional angiogram showed complete occlusion of all tumor-feeding or bleeding vessels. RESULTS: Complete preoperative tumor embolization was achieved in 83.5% of the patients. Partial embolization was possible in 10.5%. All tumor bleedings refractory to conservative therapy and bleedings from epistaxis showed a successful outcome. CONCLUSIONS: In vascular lesions and tumors of the head and neck, preoperative percutaneous embolization improved the surgical outcome, reduced intraoperative blood loss significantly and facilitated tumor resectability. Cervicofacial bleeding resulting from a tumor, vascular malformation or epistaxis can be managed effectively by endovascular techniques.     

Maxillofacial vascular malformation associated with abnormal communication between external carotid and cranial arteries]

OBJECTIVE: To introduce the clinical characteristics of maxillofacial vascular malformation with abnormal communication between external carotid and cranial arteries. METHODS: One hundred and twenty patients with maxillofacial vascular malformations had been studied by arteriography of internal and external carotid, and vertebral arteries before embolization of tumor supplying artery. Cases found to have communications between extra- and intra-cranial arteries were analyzed. RESULTS: Fourteen patients (11.67%, 14/120) were found to have abnormal communications between external carotid and cranial arteries. Among them, 11 patients demonstrated communications between occipital and vertebral arteries, 1 patient showed ascending pharyngeal artery and vertebral artery communication, and 2 patients showed maxillary artery-ophthalmic artery communication. CONCLUSION: Embolization of tumor supplying artery is a safe and practical method for the treatment of maxillofacial vascular malformation when done under digital subtraction angiography and superselective catheterization to avoid the abnormal communicant branches.     

血管内栓塞在鼻咽血管纤维瘤的应用

目的 探讨术前超选择性血管内栓塞对鼻咽血管纤维瘤的疗效和安全性。方法 在术前3～5d，对21例鼻咽部血管纤维瘤进行DSA检查和微导管超选择栓塞肿瘤供血动脉，栓塞的材料包括PVA颗粒、明胶海绵和真丝线段等。栓塞后行手术切除肿瘤。结果 鼻咽血管纤维瘤主要由同侧的领内动脉供血19例，主要由咽升动脉供血2例，同侧或双侧的颈内动脉参与供血为9例。21例病人均栓塞成功，其中13例肿瘤染色完全消失，8例肿瘤染色大部分或部分消失。肿瘤全切除者19例，部分切除者2例，全切除率为90．5％。术中出血明显减少，术中及术后无严重并发症。结论 鼻咽血管纤维瘤的术前栓塞有助于减少术中出血，提高手术安全性及全切率，是一种安全、有效的微侵袭方法。     

合并颅内外动脉异常交通支的颌面部血管畸形的诊治

目的分析颌面部血管畸形合并颅内外异常交通支的临床资料及特点,为避免脑异位栓塞提供参考。方法分析对有适应证的120例颌面部血管畸形行患侧颈内、外动脉和椎动脉造影及供瘤动脉栓塞治疗中14例合并颅内外动脉异常交通支患者的临床资料。结果14例中9例栓塞前,5例栓塞后发现颅内外存在异常交通支,占同期血管内栓塞治疗病例的11.7%(14/120),其中枕-椎动脉交通11例,咽升-椎动脉交通1例,颌内-眼动脉交通2例。14例中蔓状血管瘤（动静脉畸形）9例,海绵状血管瘤（静脉畸形）4例,葡萄酒色斑并巨唇症1例。结论当颌面部血管畸形合并颅内外异常交通支时,在数字减影血管造影术（digital subtraction