选择性血管内栓塞治疗难治性鼻出血的临床分析

目的：了解选择性血管内栓塞治疗难治性鼻出血的疗效及影响疗效的因素。方法：23例难治性鼻出血患者在颈动脉数字减影血管造影(DSA)的基础上行选择性颌内动脉末梢病变血管内栓塞，其中5例同时栓塞面动脉。结果：DSA证实23例患者均存在颌内动脉末梢发育不良或畸形，15例伴有出血征象，6例并面动脉形态异常。治愈22例，其中l例24h内复发鼻出血者证实有新侧支供血，经补加栓塞后出血停止，治愈率为95．6％。l例治疗失败，与栓塞前去除鼻腔填塞物有关，且不能除外有面动脉出血。结论：难治性鼻出血与颌内动脉发育不良及畸形有关，选择性血管内栓塞治疗能收到迅速而满意的疗效。治疗失败与潜在侧支开放或面动脉出血有关，过早去除鼻腔填塞物也是影响栓塞疗效的因素。

Clinical analysis of selected transarterial embolization in treating uncontrolled epistaxis

Objective:To learn the effects and the correlative factors of selected transarterial embolization in treatment of uncontrolled epistaxis.Method:The abnormal ends of internel maxillary artery were selected embolized in 23 patient of uncontrolled epistaxis by digital subtraction angiography (DSA) of carotid, meanwhile the facial artery were also embolized in 5 patients.Result:It was confirmed that hypogenesis and malformation in the ends of internal maxillary artery were existed in all 23 cases during DSA. There was evidence of bleeding in 15 patients, and facial artery with abnormal shape was found in 6 patients. Nose-bleeding was stopped in 22 cases ( 95.6%) after embolized, including one had a recurrence of bleeding in 24 hours because of the foundation of new abnormal communications. The fail in one case might be related with taking out all the stuff in noses before embolization and/or bleeding facial artery.Conclusion:Uncontrolled epistaxisis in this report might be caused by hypogenesis and malformation of internal maxillary artery. The effects of selected transarterial embolization were rapid and satisfactory. The fail in treatment might be related to foundation of new abmormal communications and bleed from facial artery. Taking out all the stuff in noses too early might also influence the effects of embolization.