难治性鼻出血的血管内栓塞治疗的临床应用

目的:探讨难治性鼻出血的选择性血管造影诊断和超选择性血管栓塞治疗。方法:用Seldinger技术经股动脉穿刺,置入导管鞘,进4FHead-Hunt导管或Simmons导管行双侧颈总动脉造影,明确出血部位,出血动脉及有无颅内外危险吻合后,将导管超选择性插入出血的颈外动脉分支。用医用明胶海绵进行栓塞,直到责任血管全部栓塞为止。结果:8例病人造影显示出血动脉为颌内动脉分支或面动脉分支,在栓塞术完成后立即取出鼻腔填塞物均未再出血。观察3d~10d后好转出院,随访2个月~30个月无复发。栓塞术后出现面部疼痛、肿胀感、张口受限、低热等症状,均经对症处理后缓解好转。本组未发生误栓颈内动脉系统等严重并发症。结论:选择性颈外动脉分支栓塞术具有安全、快捷、简便、止血效果可靠等优势,为难治性鼻出血的治疗开辟了一条新途径。

Clinical Application of Embolization in Intractable Epistaxis

Objective To investigate selective angiography diagnosis and superselective embolization in intractable epistaxis.Methods Under femoral artery puncture and catheter introducer leaving,bilateral common carotid artery angiography was pertormed with 4F Head-Hunt or simmons angiographic catheter.We superselectively inserted the catheter to the branch of external carotid artery after confirming the bleeding site,hemorrhagic artery and external-internal cranial dangerous anastomoses.Sponge gelfoam was used for embolic agents till completely emboliza tionarrived.Results The angiography of 8 epistaxis patients revealed bleeding artery from internal maxillary and facial artery branch.The nasal packingwere taken away immediately after the embolization,without bleeding.All the patients discharged after3~10 hospital observation,no recurrent with follow-up 2~30 months.Facialpain,swelling,limitation of open mouth,low fever appeared and released bysymptomatic treatment.No serous complication occured in this group.Conclusion Selective external carotid artery branch embolization is a safe,simple,effective and rapidmethod in the treatment with refractory epistaxis.