难治性鼻出血的血管内栓塞治疗的临床应用.DOCVIP

临床医学论文-难治性鼻出血的血管内栓塞治疗的临床应用 ??????????????????????? 作者：徐强，黄优华，沈涛，石红建，顾玲，陈文明，包燕东 【关键词】? 鼻出血；栓塞；血管造影 　　［摘? 要］ 目的：探讨难治性鼻出血的选择性血管造影诊断和超选择性血管栓塞治疗。方法：用Seldinger技术经股动脉穿刺，置入导管鞘，进4F HeadHunt导管或Simmons导管行双侧颈总动脉造影，明确出血部位，出血动脉及有无颅内外危险吻合后，将导管超选择性插入出血的颈外动脉分支。用医用明胶海绵进行栓塞，直到责任血管全部栓塞为止。结果：8例病人造影显示出血动脉为颌内动脉分支或面动脉分支，在栓塞术完成后立即取出鼻腔填塞物均未再出血。观察3 d~10 d后好转出院，随访2个月~30个月无复发。栓塞术后出现面部疼痛、肿胀感、张口受限、低热等症状，均经对症处理后缓解好转。本组未发生误栓颈内动脉系统等严重并发症。结论：选择性颈外动脉分支栓塞术具有安全、快捷、简便、止血效果可靠等优势，为难治性鼻出血的治疗开辟了一条新途径。 　　［关键词］ 鼻出血；栓塞；血管造影 　　Clinical Application of Embolization in Intractable Epistaxis 　　Abstract:Objective To investigate selective angiography diagnosis and superselective embolization in intractable epistaxis．Methods Under femoral artery puncture and catheter introducer leaving，bilateral common carotid artery angiography was pertormed with 4F HeadHunt or simmons angiographic catheter．We superselectively inserted the catheter to the branch of external carotid artery after confirming the bleeding site，hemorrhagic artery and externalinternal cranial dangerous anastomoses．Sponge gelfoam was used for embolic agents till completely emboliza tionarrived．Results The angiography of 8 epistaxis patients revealed bleeding artery from internal maxillary and facial artery branch．The nasal packingwere taken away immediately after the embolization，without bleeding．All the patients discharged after3~10 hospital observation，no recurrent with followup 2~30 months．Facialpain，swelling，limitation of open mouth,low fever appeared and released bysymptomatic treatment．No serous complication occured in this group．Conclusion Selective external carotid artery branch embolization is a safe，simple，effective and rapidmethod in the treatment with refractory epistaxis．　　　　Key words:Epistaxis；Emboliztion；Angiography ??? 难治性鼻出血是耳鼻喉科常见急诊，多数患者鼻出血来源于鼻前庭，易于治疗。但对于少数上鼻腔及后鼻腔出血患者处理十分棘手，特别是经后鼻孔填塞治疗失败后，我科自2002年5月至2005年3月对8例难治性鼻出血患者，采用经血管内超选择造影诊断并行栓塞治疗，效果良好，现报告如下。 　　1? 材料与方法 　　本组8例病人均为男性，年龄26岁～65岁，平均42岁。其中3例为高血压性鼻出血，2例为自发性鼻出血，3例为外伤性鼻出血。用Seldinger技术经股动脉穿