鼻内镜下蝶腭动脉银夹夹闭术治疗顽固性鼻出血

目的探讨鼻内镜下定位游离蝶腭动脉并以银夹夹闭治疗顽固性鼻出血的方法。方法对22例经反复鼻腔填塞及鼻内镜下电凝术治疗后仍有顽固性鼻腔后部出血的患者于全麻或局麻下行鼻内镜检查，在中鼻甲后端附着部纵向切开黏骨膜，寻找蝶腭孔并充分解剖蝶腭动脉主干及分支，以1～2枚银夹夹闭，复位黏骨膜瓣并填塞止血纱布和膨胀海绵。结果随访6—36个月，平均23个月。20例未再出血，2例分别于术后第6个月和9个月再次同侧筛动脉出血，经鼻内镜下电凝及填塞压迫止血后痊愈。结论鼻内镜下解剖蝶腭动脉并以银夹夹闭治疗顽固性鼻出血，方法简单，疗效确切，值得临床推广。

Endoscopic sliver clipping of the sphenopalatine artery as the primary management for refractory epistaxis

Objective To investigate the methodology and reliability of endoscopic sphenopalatine artery sliverclipping in management of refractory epistaxis. Methods Twenty-two patients with severe intractable posterior epistaxis who bad undergone various procedures like nasal packing, electro-or-chemical cautery or others and still exacerbated, were subjected to this study. Performed nasal endoscopy under general or local anesthesia. Then located sphenopalatine foramen and anatomized sphenopalatine artery and its branches after the longitudinal incision of mucoperiosteum which was at the attachment of the posterior part of the middle turbinate. Afterwards, one or two sliver clips were used to occlude sphenopalatine artery and its branches. Finally, reset mucoperiosteal flap and filled it with hemostasis gause and expansive sponge. Results Twenty-two patients had been followed up for 6 to 36 months with an average of 23 months. Twenty patients did not suffered from recurrent epistaxis during the period. Only 2 patients suffered from recurrent epistaxis in the sixth month and the ninth month respectively. They did not suffered from epistaxis after electric cautery the anterior ethmoidal artery on the same side. Conclusions Sliver-clipping of the sphenopalatine artery, as a purely endonasal procedure is an effective and microinvasive means of achieving long-term control of refractory epistaxis. It has few complication compared with the other forms of arterial ligation.