鼻内镜下动脉性鼻出血的综合治疗.PDFVIP

中国耳鼻咽喉头颈外科/2007年5月,第14卷,第5期 论 著 鼻内镜下动脉性鼻出血的综合治疗 罗克强，杨大章，王娜亚，刘丹丹 （卫生部中日友好医院耳鼻咽喉科，北京　100029） [摘 要]　目的　探讨鼻内镜下治疗鼻腔深、浅部动脉 and characteristics of micro-traumatic therapy for 性出血的方法及特点。方法　以电热烧灼术、高频电凝 severe superficial or deep-seated intractable arterial 术、微波凝固术及微创填塞法治疗深、浅部动脉性鼻出 epistaxis(IAE). METHODS　 Under nasal endoscopic 结果 血。 　487例患者中，电热烧灼术治疗327例浅部鼻 monitoring, electric heat cauterization(EHC), high 出血患者，均治疗成功；微波烧灼术治疗135例浅部鼻 frequency electric coagulation(HFEC), microwave 出血患者，其中有40例患者在活动性出血状态下，治疗 coagulation(MC) and micro-traumatic nasal 失败，改用电热烧灼法治疗均获成功；高频电凝术治疗 packing(MTNP) were applied respectively for 鼻腔后部动脉性出血15例及嗅裂区微创填塞术治疗筛顶 management of severe superficial or deep-seated 部动脉出血10例，均获成功。经随访治疗后4周以内， IAE in 487 patients. RESULTS　EHC was applied on 原部位均未再次出血。结论　①隐蔽部位即中、下鼻道 327 patients with superficial IAE and all the patients 侧后部及嗅裂筛顶部等往往是顽固性鼻出血发生的常见 got successful outcome. MC was applied on 135 with 区域；②动脉性鼻出血内镜下微创治疗是可靠、方便、 superficial IAE and bleeding was not successfully stopped 有效的方法；③微波凝固术不适宜治疗活动性动脉出血 in 40 cases with active hemorrhagic state. They were 点，这与微波不能有效加热凝固快速流动的血液有关； successfully treated later by EHC. While the HFEC ④对于静止的或活动性的动脉出血点电热烧灼术及电凝 was applied on 15 patients with postnasal IAE and the 术均能施行有效热凝治疗，为最迅速和可靠的止血方法 olfactory fissura area MTNP was applied on 10 patients 之一；⑤嗅裂筛顶部动脉出血点适宜用可吸收性止血材 with sieve roof IAE and all the cases got successful 料微创填塞法治疗；⑥动脉性鼻出血好发于中老年人 outcome. All the cases were followed up for 4 weeks and 群，以男性为常见，常发生于鼻中隔前中部，即鼻腔动 no bleeding occurred in the former location with any of the 脉末梢部；⑦高血压病及动脉粥样硬化可能是动脉性鼻 4 methods. CONCLUSION　①The lateral or posterior 出血的主要原因，且与季节、吸烟和饮酒有一定关系。 area of middle and inferior