133例鼻手术中鼻内镜下控制鼻出血疗效观察.docVIP

鼻腔手术中鼻内镜下控制鼻出血疗效观察，口腔写手。 摘要：目的 探讨鼻腔手术中使用鼻内镜下电凝止血和结扎止血等方法以减少术后鼻腔填塞的的有效性和安全性。方法 自2007年9月至2009年9月，共有133名患者在我院耳鼻喉科接受鼻腔手术及在鼻内镜控制鼻出血，其中鼻中隔成形术17例（12.8%），鼻甲切除42例（31.5%），内镜治疗鼻息肉及鼻肿瘤74例（55.6%）。结果 术后117例（88%）患者止血效果满意，不需进行鼻腔填塞，仅16例（12%）患者需进行鼻腔填塞治疗。53例（39.8%）患者仅使用鼻内镜下电凝止血，29例（21.8%）患者结扎碟腭动脉,仅有2例（1.5%）患者结扎筛前动脉。另有34例（25.5%）患者术中鼻内镜下显示无明显出血，因而未采取止血措施。在未进行鼻腔填塞的患者中，只有8例（6.8%）需要术后填塞，而在接受鼻腔填塞治疗的患者中有2例（12.5%）出现再次出血并接受进一步手术。结论 由于鼻腔手术后出血发生率较低，术中预防性使用鼻腔填塞治疗并非必须。使用术中鼻内镜下止血可使多数患者避免使用鼻腔填塞治疗。 关键词：鼻出血，鼻腔填塞，鼻内镜，碟腭动脉结扎，筛前动脉结扎 [Abstract] Objective: :This study aims to evaluate the advantages of this approach at nasal surgery to prevent routine nasal packing. Method: 133 subjects were operated on by the same surgeon from 2007.9 to 2009.9. 17 (12.8%) patients were submitted to septoplasty, 42 (31.5%) to turbinoplasty (in 22 accompanied septoplasty) and 74 (55.6%) to endoscopic sinus surgery (ESS) for nasal polyposis or nasal tumors. Results: Only 16 cases (12%) underwent nasal packing, while in the remaining 117 (88%) endoscopic control of bleeding avoiding packing. In 53 (39.8%) patients only an endoscopic cauterization of bleeding points was performed; in 29 (21.8%) sphenopalatine artery ligation was necessary. Only 2 subjects (1.5%) underwent anterior ethmoidal artery ligation. In the remaining (25.5%) patients no procedure was necessary, due to the apparently scarce bleeding in the endoscopic vision at the end of surgery. Of non-packed patients, only 8 (6.8%) needed a post-operative tamponade while in the group of packed patients, 2 (12.5%) cases rebleeding and a revisional surgery was necessary. Conclusion: Intra-operative precautional packing is therefore not justified during nasal surgery because of the small percentage postoperative epistaxis. Intra-operative control of bleeding allowed nasal packing to be avoided in a large percentage of cases. Keywords: Epistaxis; Nasal packing; Nasal endoscopy; Sphenopalatine artery ligation; Anterior ethmoidal artery ligation 出血是鼻腔手术的常见并发症。如于术中发生，将会增加手术的