鼻内镜下成人难治性鼻出血的处理

目的总结成人难治性鼻出血高发位置分布规律及有效微创处理方法。方法通过鼻内镜找出成人严重鼻出血位置,并以电凝进行止血。结果41例成人难治性鼻出血患者出血部位中,鼻中隔嗅裂区及鼻顶前端17例(41.5%);下鼻道后端穹隆部12例(29.3%);蝶筛隐窝下方4例(9.7%);中鼻道2例(4.9%);中隔后上端4例(9.7%);部位不明2例(4.9%)。查明出血部位的39例患者为动脉出血,均予电凝止血。结论鼻中隔嗅裂区、鼻顶前端和下鼻道后端穹隆部为鼻出血高发部位;鼻内镜下大多数出血部位均可发现;鼻内镜下电凝止血创伤微小,效果确切。

Management of Adult Obstinate Epistaxis by Endoscope

Objective To summery the rule of the sites of adult obstinate epistaxis and investigate an effective and minimally invasive management for hemostasis under endoscopy. Methods Bleeding points were searched for and treated by electro- coagulation under an endoscope. Results In all 41 cases, bleeding was found in olfactory cleft of nasal sep- turn and anterior nasal roof in 17 cases （41.5%）, at superior wall of the inferior meatus in 12 cases （29.3%）, under sphenoethmoidal recess in 4 cases （9.7%）, in middle meatus 2 cases （4.9%）, in posterosuperior area of nasal septum in 4 cases （9.7 % ） and was indefinite in 2 case （4.9 % ）. Conclusion Almost all bleeding points of adult obstinate epistaxis cases can be found under endoscopy and they are mainly distributed in olfactory cleft of the nasal septum and the top nasal septum, or at the superior wall of the inferior meatus. Electro - coagulation under endoscopy is an effective and minimally invasive management for adult obstinate epistaxis.