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。     

颌内动脉栓塞术在外伤性鼻出血中的应用

数字减影血管造影和血管栓塞技术是近年来新兴的一项技术,在耳鼻咽喉科领域常用于顽固性鼻出血、鼻腔和鼻咽部血管瘤的栓塞治疗.头面部外伤常引起严重的鼻出血,传统的止血方法很难奏效,2001～2002年间我们应用血管栓塞技术治疗3例此类患者,疗效显著.报告如下.     

超选择性血管栓塞术治疗严重鼻出血

目的 探讨超选择性血管栓塞术治疗严重鼻出血的效果。方法 回顾性分析1995年7月-2000年10月采用超选择性血管栓塞术治疗常规方法不能控制的6例严重鼻出血,总结经验和教训。结果 5例一次栓塞成功,1例因栓塞物返流并发脑梗塞死亡。结论 超选择性血管栓塞术可直视下辨明出血血管,栓塞效果显著,但有严重并发症的潜在危险,应严格掌握适应证。     

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。     

头颈部血管性疾病的介入诊治

目的评价介入诊疗技术在头颈部血管性疾病中的诊断和治疗价值。方法对采用Seldinger技术动脉插管造影、栓塞进行诊断和治疗的鼻咽纤维血管瘤、外伤性颈内动脉海绵窦瘘、头面部血管瘤、难治性鼻出血等32例进行回顾性分析。结果32例数字减影血管造影(DSA)成像中,除6例血管瘤无显影,2例腭、颈部肿块明确为颈内动脉瘤而瘤体与颈内动脉共壁无法栓塞之外,其余24例均成功进行了栓塞治疗。栓塞作为单一治疗方式的11例中,颈内动脉海绵窦瘘1例、难治性鼻出血5例、蔓状血管瘤4例均一次栓塞治愈,1例Ⅲ期鼻咽纤维血管瘤姑息性栓塞控制了症状;栓塞辅以手术治疗的13例,术中出血量明显减少,其中6例鼻咽纤维血管瘤,术中平均出血量为260ml,7例血管瘤术中平均出血量为150ml。结论DSA造影在头颈部血管性病变中能显示供血动脉、异常交通支、动静脉瘘等清晰的动态图像,指导临床治疗方法的选择;血管内栓塞治疗对颈外动脉系统的难治性鼻出血、颈内动脉海绵窦瘘、部分血管瘤显示出良好的治疗效果;对血运丰富的肿瘤,术前栓塞可显著减少术中出血,大大提高手术的安全性。     

颅底颈内动脉瘤15例临床分析

目的探讨颅底颈内动脉瘤的诊断和临床特点。方法收集山东第一医科大学附属省立医院1995—2017年接受数字减影血管造影(DSA)或CT血管造影(CTA)检查确诊的15例颅底颈内动脉瘤患者的临床资料进行分析。15例患者中男12例,女3例;年龄17~67岁,中位年龄44岁。15例患者中DSA确诊13例,CTA确诊2例;首发症状为鼻出血的假性动脉瘤13例,其中有明确的头面部外伤史8例,颅底肿瘤放疗史5例;头痛伴颅神经障碍的真性动脉瘤2例。15例患者采用栓塞和/或手术修复等治疗,所有患者治疗后随访2~12年,观察患者是否治愈及存活状态。结果 8例外伤史患者中5例行血管栓塞治疗痊愈;2例患者未行血管栓塞,之后因大量鼻出血死亡;1例血管栓塞术后出现进行性脑梗死,之后死亡。5例颅底肿瘤放疗后患者,1例行血管栓塞后脑梗死,之后死亡;2例行血管栓塞后因原发肿瘤复发侵及颅内,于院外死亡;1例行血管栓塞联合手术治疗恢复良好;1例放弃治疗,院外大出血死亡。首诊为头痛的2例患者,1例误行手术致鼻出血后于院外行血管栓塞治疗;1例因个人原因放弃治疗死亡。总计院内死亡4例,院外死亡4例,生存7例。结论颈内动脉瘤是颅底病变中的高危疾病,伴有外伤、放疗史的鼻出血及头痛伴颅神经障碍的患者应考虑颈内动脉瘤可能,需行DSA、CTA检查进行确诊。耳鼻咽喉科医生正确诊断与治疗对患者预后至关重要。     

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。     

数字减影血管造影在耳鼻咽喉科应用的初步报告

对１１例耳鼻咽喉科疾病进行了数字减影血管造影检查，其中１０例同时行栓塞治疗，通过ＤＳＡ可以了解各种血管瘤的供血来源，病变范围，静脉引流等情况，术前栓塞肿瘤的供血血管，术中出血量明显减少。对外伤性鼻出血，应用ＤＳＡ在直视下辨明血血管，栓塞该血管达到止血目的。对外伤性生动脉瘤，通过ＤＳＡ可确定病变部位，且可同期进行栓塞治愈。并对ＤＳＡ在耳鼻咽喉科应用的适应证，并发症及其预防措施进行了讨论。     

数字减影血管造影对严重后鼻部出血的应用价值

报告对３例经多种方法治疗不能止血的严重后鼻部出血患者，以数字减影血管造影查明了不常见的病因；并用之行栓塞治疗，２例出血停止，１例虽栓塞双侧颌内动脉，但未控制出血，改行其他方法血止。表明ＤＳＡ对控制由颌内脉病变引起鼻出血是一种有效的新方法，并就ＤＳＡ栓塞治疗的优点和适应证等进行讨论。     

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     

Uncontrollable epistaxis. Angiographic localization and embolization

The method of choice for uncontrollable epistaxis that is refractory to anterior and posterior nasal packing is controversial. In a retrospective study, the therapeutic results in 42 patients with uncontrollable epistaxis were reviewed, with special consideration of 11 cases in which the patients received angiography and embolization of branches of the internal maxillary artery. Out of this collective, only one patient received surgery, ie, transantral internal maxillary artery ligation. The results of primary embolization demonstrated the effectiveness and illustrated the potential role of embolizing procedures in uncontrollable epistaxis.     

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。     

Treatment of intractable epistaxis using arterial embolization

Arterial embolization has become the procedure of choice for managing intractable epistaxis in certain centres in North America and Europe, with arterial ligation reserved for those patients in which it fails. In Ireland, the role of this relatively new technique is poorly defined. The aim of this retrospective study was to investigate the outcome of all patients who underwent arterial embolization for intractable epistaxis in Dublin since it was introduced in 1998. Embolization resulted in complete and immediate resolution of epistaxis in 10 out of 12 patients (82%). Two patients required carotid ligation because of persistent epistaxis. One other patient had a further minor epistaxis 2 days following embolization, which was treated successfully with cautery. No major complications occurred in any of the patients. This study suggests that arterial embolization is an effective and safe method of managing patients with intractable epistaxis.     

Angiographic Embolization for Epistaxis: A Review of 114 Cases

Angiography with selective embolization has become an accepted method of treating posterior epistaxis that is not controlled with conservative measures. The authors reviewed 112 cases of patients who had received selective angiographic embolization for refractory epistaxis from January 1990 to December 1995. There were 114 embolizations over this 5-year period. The immediate success rate was 93%, with long-term success achieved in 88% of patients. The overall complication rate was 17%, with the long-term morbidity rate less than 1%. Selective angiographic embolization is a safe and effective method that should be considered in the treatment of refractory epistaxis.     

Embolization for the treatment of idiopathic posterior epistaxis

BACKGROUND: The goal of this study was to examine safety and efficacy of transarterial embolization for the treatment of idiopathic posterior epistaxis. METHODS: A retrospective chart review was conducted to characterize the underlying conditions of eighty-one consecutive patients for whom complete records were available presenting with posterior epistaxis, the associated risk factors for patients with idiopathic posterior epistaxis, and the success rate of embolization in this patient population. RESULTS: One hundred consecutive patients undergoing embolization for epistaxis were identified and 81 patients were included in the analysis. Nineteen patients did not have sufficient and retrievable medical records to be included in the study. Idiopathic posterior epistaxis was the most common underlying etiology of patients with refractory posterior epistaxis (34%). Hypertension, vascular disease, and diabetes were frequently detected comorbid diseases. Patients were equally as likely to be hypertensive as normotensive at the time of presentation (45 and 55%, respectively). Most patients (83%) had failed at least one prior treatment modality. Few patients had a recurrence of epistaxis within 72 hours (three patients [12%]) or had an adverse effect associated with embolization (three patients [12%]). CONCLUSION: Embolization for the treatment of posterior epistaxis is a safe and effective treatment modality.     

Embolización selectiva terapéutica en epistaxis incoercibles

Epistaxis is a common otolaryngologic emergency that is controlled frequently with conservative measures. on the other hand, more aggresive treatments are requiered in refractory or severe epistaxis, which may have systemical impact. about intractable posterior epistaxis, selective embolization of external carotid territory is an effective option for managing. three patients with severe epistaxis successfully treated with selective embolization and a review of literature are exposed     

Percutaneous embolization to control intractable epistaxis

Recurrent epistaxis is a common manifestation of patients with a bleeding diathesis. Two patients with epistaxis secondary to a bleeding diathesis managed by local conservative techniques are reviewed. (A case of polycythemia vera and a case of liver failure secondary to hepatoma are reviewed.) Recently bilateral, percutaneous carotid angiography examination was performed on a patient with a bleeding diathesis and intractable epistaxis. At the time of the angiographic examination, embolization of both internal maxillary arteries with Gelfoam particles was accomplished and dramatic control of the epistaxis was achieved. In a patient with severe epistaxis secondary to a bleeding diathesis that is unresponsive to local measures, percutaneous Gelfoam embolization offers substantial advantages over surgical intervention.     

创伤性迟发性鼻出血与假性动脉瘤关系的临床研究

目的 探讨创伤性迟发性鼻出血的诊断和治疗方法,并提出创伤性颌面部中小动脉假性动脉瘤性鼻出血的概念.方法 回顾性总结、分析了1990年3月-2005年3月期间山东省立医院耳鼻咽喉科收治的表现为创伤性迟发性鼻出血并接受数字减影血管造影检查和治疗的53例患者的有关资料.结果 该53例患者中,颈内动脉假性动脉瘤8例,其中7例行血管栓塞治疗,6例痊愈,1例死亡;另1例未行栓塞,在行建立侧支循环功能训练时出血死亡;颈内动脉海绵窦瘘20例,均使用可脱性球囊栓塞成功;颌面部中小动脉出血25例,21例为上颌动脉和或面动脉分支出血,使用明胶海绵颗粒结合弹簧圈行血管栓塞治疗,4例筛前动脉出血者行筛前动脉结扎术.随访6～72个月,中位随访时间为5年.除1例上颌动脉栓塞者再次鼻出血外,其余患者随访期间均未再出血,未发生严重并发症.结论 颈内动脉假性动脉瘤、颈内动脉海绵窦瘘、颌面部中小动脉假性动脉瘤性鼻出血是导致创伤性迟发性鼻出血主要原因,采用数字减影血管造影技术明确诊断并进行血管内栓塞或动脉结扎是治疗该类疾病的有效办法.     

Facial nerve paralysis following embolization for severe epistaxis (case report and review of the literature)

Embolization to treat intractable epistaxis is becoming increasingly popular. Twelve cases of facial nerve paralysis after embolization of branches of the external carotid artery have been reported. In this paper, a new case is reported. In epistaxis, embolization should be reserved for patients with contraindications to ligation or in emergency procedures.     

介入治疗鼻咽癌放疗后颈内动脉假性动脉瘤破裂大出血

目的探讨鼻咽癌放疗后颈内动脉假性动脉瘤破裂大出血的救治方法。方法3例鼻咽癌放疗后颈内动脉假性动脉瘤破裂大出血病人,采用数字减影血管造影术检查,明确颈内动脉假性动脉瘤破裂部位,在双侧大脑血管造影明确脑底Willis环交通通畅后,用球囊栓塞颈内动脉破裂处。结果3例均止血成功。1例术后1周后死亡;1例出院后3个月死亡,死因不明;另1例存活至今。结论对脑底Willis环交通通畅者,采用颈内动脉栓塞治疗鼻咽癌放疗后颈内动脉假性动脉瘤破裂大出血止血效果确切。但对于有放射性脑病的病人可能发生严重的并发症。