功能性内窥镜鼻窦手术出血的预防

目的探讨功能性内窥镜鼻窦手术(FESS)出血的相关因素及预防措施。方法对144例实施 FESS，对患者术中出血量及相关因素进行统计学分析。结果144例中出血量为20～700ml，其中20m1～2例 (14.6％)，50ml～47例(32.6％)，100ml～54例(37.5％)200ml～18例(12.5％)，500ml～4例(2.8％)。术中易 损伤的血管是筛前动脉及筛后动脉，蝶腭动脉和鼻后中隔动脉，颈内动脉。多次手术的患者因瘢痕组织中血 管失去弹性和病变处血管异常增生是术中出血的重要因素。手术全麻和手术时间长可增加出血。结论为 减少FESS术中出血，术者须熟悉鼻窦解剂学，术前仔细阅读CT片，了解病变范周及解剖学变异。术中要清 楚每一步操作处的解剖位置，仔细辩认术区的重要血管并加以保护，术前常规使用1％肾上腺素收敛鼻黏膜 血管可减少术中出血。

Prevention of bleeding in functional endoscopic sinus surgery (FESS)

Objective: To study the relative factors and prevention of bleeding in FESS. Method: One hundred and forty - four cases received FESS were statistically analysed. Results:The amount of bleeding in 144 cases ranged from 20ml to 700mi,including 20ml～,2 cases;50ml ～,47 cases; 100ml ～,54 cases;200ml ～, 18 cases;500ml～,4 cases. Anterior ethmoidal artery, posterior ethmoidal artery, sphenopalatine artery, posterior nasal septum artery and internal carotid artery were easily injured during operation. The reason for bleeding was the non- elasticity and abnormal hyper plastic of blood vessels in scar tissue, and general anesthesia and long - term operation may lead to increasing of bleeding. Conclusion:The operator should carefully study the CT sheet so as to get the pathologic change and the variety of anatomy, protect the important blood vessels located in the operative region, and use 1% adrenalin as astringent for the nasal mucosa vessel,thus the amount of bleeding may be reduced.