选择性动脉栓塞术治疗顽固性鼻出血

目的探讨顽固性鼻出血的血管造影特点以及选择性动脉栓塞术治疗的临床疗效、并发症及注意事项。方法对16例顽固性鼻出血患者行选择性颈外和（或）颈内动脉造影术及选择性上颌动脉和（或）面动脉栓塞术。栓塞剂为明胶海绵颗粒（条）、弹簧圈。结果 16例患者中,15例动脉造影见阳性征象,1例为阴性。栓塞靶血管后,14例止血效果良好;对2例合并筛动脉出血患者于栓塞术后次日行筛动脉结扎术,出血得到完全控制。所有患者均未出现与栓塞相关的严重并发症。结论选择性动脉造影及栓塞术可快速诊断及有效治疗顽固性鼻出血;对有筛动脉参与的鼻出血,应结合动脉结扎手术进行治疗。

Selective transcatheter arterial embolization for intractable epistaxis

Objective To analyze the angiographic characteristics of epistaxis, and to observe the clinical effect, complications and concerning precautions of selective transcatheter arterial embolization for the treatment of intractable epistaxis. Methods Digital subtraction angiography (DSA) of external and/or internal carotid artery were performed in 16 patients with intractable epistaxis, and then the maxillary and/or facial artery were embolized with Gelfoam and/or coils. Results DSA showed abnormalities in 15 patients. Embolization resulted in immediate hemostasis in 14 cases. Hemorrhage was controlled in the other 2 cases after ethmoidal artery ligation the next day. No serious complications occurred after selective arterial embolization. Conclusion Selective transcatheter arterial angiography and embolization are effective in the diagnosis and treatment of intractable epistaxis. However, for epistaxis due to ethmoidal artery, the ligation of bleeding artery is necessory.