鼻内镜手术治疗难治性鼻出血

目的探讨鼻内镜手术应用于急诊处置难治性鼻出血的可行性,手术适应症及术中注意事项。方法对34例经常规前、后鼻孔填塞或鼻内镜下填塞止血失败的患者分别施行鼻内镜下鼻中隔矫正术（11例）、中鼻甲部分切除术（9例）、下鼻甲骨折内/外移术（11例）、下鼻甲部分切除术（3例）,矫正解剖畸形及鼻腔局部扩容以助明确出血部位,再局部填塞或电凝止血。结果所有手术均顺利完成,其中出血部位位于嗅裂区10例,下鼻道穹窿12例,中、下鼻甲后方3例,中鼻道3例,鼻中隔后份2例,蝶窦开口1例,出血部位不明3例。所有病例均一次成功止血,未出现鼻中隔穿孔等并发症;随访3个月以上,未发生严重的鼻出血。结论在难治性鼻出血处置中合理运用鼻内镜手术有利于较快明确出血部位,切实止血。

Transnasal endoscopic surgery in treatment of refractory epistaxis

Objective To explore the feasibility of using transnasal endoscopic surgery for treating refractory epistaxis.Method 34 patients with severe intractable epistaxis underwent frustrated standard nasal packing,and in conventional endoscopic examination failed to reveal the bleeding points were performed endoscopic surgery,including nasal septal construction（11cases）,partial middle turbinectomy（9 cases）,inferior turbinate bone fracture internal/external shift operation（11 cases）,partial inferior turbinectomy（3 cases）.Through the rectification of anatomical deformity and nasal expansion and the bleeding points were identified,and dealed with local tamponade or electrocoagulation.Results All the operation were successful.The bleeding points were found in the following different sites： olfactory cleft（10 cases）,vault of inferior nasal meatus（12 cases）,posterosuperior wall of middle or inferior turbinate（3 cases）,middle nasal meatus（3 cases）,posterior part of anasl septum（2 cases） and uncertain（3 cases）.All cases were successfully stop bleeding after one time of treatment,no complications such as perforation of nasal septum and severe epistaxis were occurred during a followed-up for more than 3 months.Conclusion Rational use of nasal endoscopic operation in the disposal of refractory nasal bleeding is beneficial to quickly clear the bleeding site and effective hemostasis.