鼻内窥镜下诊治难治性鼻出血68例分析

目的：探讨难治性鼻出血常见的出血部位及治疗方法。方法:回顾分析经内窥镜诊治的难治性鼻出血68例的临床资料，分析其出血部位及治疗效果。结果:出血部位在下鼻道顶部占27.9%(19/68)、嗅裂鼻中隔占20.7%(14/68)、中鼻道后上部占16.1%(11/68)、中鼻甲后端蝶腭动脉区和鼻中隔后端均为10.3%（7/68）、鼻咽顶占5.9%（4/68）、Woodruff静脉丛和部位不明均为4.4%(3/68)。1次治愈59例(86.7%)，2次9例(13.3%)，随访1～3个月均无复发。结论:应用鼻内窥镜检查鼻腔深部的出血并在镜下电凝或填塞止血安全有效。

Rhinoscopy for 68 patients with intractable epistaxis

Objective: To investigate the common nasal bleeding points and the management for intractable epistaxis. Methods: The bleeding points, surgical techniques and the curative effect were studied retrospectively in 68 patients, in whom the hemorrhage was not controlled with standard nasal packing. Results: The bleeding points were found in the following different sites: superior wall of inferior nasal meatus, 27.9% (19/68); olfactory cleft of nasal septum, 20.7% (14/68); posterosuperior wall of middle nasal meatus, 16.1% (11/68); sphenopalatine artery zone of posterior middle turbinate, 10.3%（7/68）; posterior of nasal septum, 10.3%（7/68）; superior wall of nasopharynx, 5.9%（4/68）; Woodruff venous plexus, 4.4% (3/68) and the uncertain, 4.4% (3/68). Epistaxis was well controlled in 65 cases by electrocoagulation, and in 3 cases by gelfoam packing. There were no complications during a follow up for 1 3 months. Among the 68 patients, bleeding was stopped in 59 ( 86.7%) after once treatment, while in 9 cases(13.3%) after twice. Conclusion: Endoscopy provides an effective and safe way to visualize and manage the deeply sited bleeding points.