难治性鼻出血临床治疗.docVIP

难治性鼻出血临床治疗 　　【摘要】 目的 探讨难治性鼻出血的临床处理思路及治疗经验。方法 回顾性分析156例难治性鼻出血患者的临床资料，针对出血患者采用序贯治疗：首先应用鼻内窥镜检查鼻腔并在内镜下射频或电凝止血，上述方法治疗无效者,采用数字减影血管造影(DSA)上颌动脉栓塞治疗。结果 156例患者，鼻内窥镜检查和治疗一次性治愈139例,二次治愈6例，治愈率为92．9%。经鼻内窥镜检查和治疗后出血仍未能控制者11例，行血管造影并栓塞治疗，治愈率为100%。结论 采用鼻内镜技术结合数字减影血管造影两种方法序贯治疗难治性鼻出血，疗效满意。 　　【关键词】鼻出血；鼻内窥镜检查；数字减影血管造影 　　 　　Clinical therapic procedure of intractable epistaxis 　　 　　WU Xuan,CHEN Xi-hui,SU Zhen-zhong.Department of Otolaryngology,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China 　　 　　【Abstract】 Objective To investigate the clinical treatment consideration and the therapic experience of intractable epistaxis.Methods The clinical data of 156 cases of intractable were retrospectively analyzed,The sequential therapy was selected to the treatment：first,using the methods including nasendoscopy and radio frequency or electric coagulation to stop bleeding,when these methods were ineffective,then Used digital subtraction angiography localization and embolization.Results All of the patients,the numbers of nasendoscopy treatmentneeded to stop bleeding were 139 cases after 1 time of treatment,6 cases after 2 times,the cure rate was 92．9%,there were 11 cases could not control,then Used digital subtraction angiography localization and embolization,the cure rate was 100%.Conclusion The thought of taking sequential therapy methods to treat the intractable epistaxis was very clear,and the curative effect is satisfactory as well. 　　【Key words】Epistaxis;Nasendoscopy;Digtal subtraction angiography 　　 　　 　　基金项目：广东省科技计划项目(项目编号：2006 　　作者单位：510080广州，中山大学附属第一医院耳鼻喉科医院 　　 　　难治性鼻出血至今仍是耳鼻咽喉科难治病症之一,其原因主要是不能准确找到出血点，本研究对2000年9月至2007年9月住院156例难治性鼻出血患者临床处理过程及诊疗方法进行总结分析,现报告如下。 　　1 资料与方法 　　1．1 临床资料 本文对难治性鼻出血的定义是：常规前鼻镜检查未发现出血点,并经规范的鼻腔填塞(前鼻孔或后鼻孔)仍未能控制的鼻出血。156例难治性鼻出血患者中,男128例,女28例,年龄15~78岁,平均41．4岁,均为单侧出血，85例伴有高血压病史,36例伴有糖尿病病史。全部病例无外伤及血液病等病史，均接受过规范的前鼻孔填塞,其中47例施行前后鼻孔填塞。 　　1．2 治疗方法 　　1．2．1 鼻内窥镜检查和治疗 应用鼻内窥镜电视监视系统,6例患者采用全身麻醉,其余均在鼻腔表面麻醉下完成。伴高血压者检查前用药控制血压。患者采用仰卧位,先