下鼻甲射频消融术后迟发性鼻出血7例分析

目的：回顾探讨下鼻甲低温等离子射频消融术后迟发性鼻出血的原因及防治对策。方法：收集我院自2008年6月至2013年1月发生的7例下鼻甲低温等离子射频消融术后迟发性鼻出血患者的临床资料,分析迟发性出血原因及防治对策。结果：7例患者行鼻内镜检查均提示手术创面感染,创口愈合欠佳。予以凡士林纱条前鼻孔填塞48 h,静脉滴注头孢唑啉钠抗感染治疗（2.0 g,2次·d^-1）5 d。其中4例患者经治疗痊愈,另外3例患者经二次鼻腔填塞及抗感染治疗无效后在鼻内镜下行双极电凝止血术后得以痊愈。随访1个月7例患者均未再出血,下鼻甲创面完全愈合。结论：下鼻甲创面感染、愈合不良是迟发性出血的主要原因。积极治疗基础疾病、提高手术操作技巧及详细的出院指导、门诊回访是预防下鼻甲低温等离子射频消融术后迟发性鼻出血的关键。前鼻孔填塞、抗感染及鼻内镜下电凝止血术是治疗的有效手段。

Clinical analysis on seven patients with late-onset nasal bleeding after radiofrequency ablation

Objective： To discuss the causes and treatments of tardive epistaxis in inferior nasal concha after temperature-controlled radiofrequency ablation（ TCRF）. Methods： During June 2008 to January 2013,the clinical data of 7 patients with tardive epistaxis in their inferior nasal concha after TCRF in our hospital were reviewed,and the causes and treatments were also analyzed. Results： Seven cases were referred to wound infection and poor healing by endoscopy,and four of them were recovered after anterior nasal packing with vaseline gauze for 48 hours and application of cefazolin sodium（ 2. 0 g,iv gtt,bid） for 5 days for anti-infection. While the rest 3 cases,after twice invalid nasal packing and anti-infection treatment,were finally recovered by bipolar coagulation hemostasis under nose introscope. No epistaxis was observed at 1 month followed-up,and the wounds in all 7 cases were healed completely. Conclusion： Wound infection and delayed healing of inferior nasal concha are the causes of tardive epistaxis. The keys for preventing epistaxis in inferior nasal concha after TCRF are active treatment on underlying disease,improvement of operation skills and detailed discharge guidance. And anterior nasal packing, anti-infection treatment and bipolar coagulation hemostasis under nose introscope are the effective methods for treatment.