【摘要】 目的探讨鼻内镜下治疗鼻腔深、浅部动脉性出血的方法及特点。方法以电热烧灼术、高频电凝术、微波凝固术及微创填塞法治疗深、浅部动脉性鼻出血。结果487例患者中,电热烧灼术治疗327例浅部鼻出血患者,均治疗成功;微波烧灼术治疗135例浅部鼻出血患者,其中有40例患者在活动性出血状态下,治疗失败,改用电热烧灼法治疗均获成功;高频电凝术治疗鼻腔后部动脉性出血15例及嗅裂区微创填塞术治疗筛顶部动脉出血10例,均获成功。经随访治疗后4周以内,原部位均未再次出血。结论①隐蔽部位即中、下鼻道侧后部及嗅裂筛顶部等往往是顽固性鼻出血发生的常见区域;②动脉性鼻出血内镜下微创治疗是可靠、方便、有效的方法;③微波凝固术不适宜治疗活动性动脉出血点,这与微波不能有效加热凝固快速流动的血液有关;④对于静止的或活动性的动脉出血点电热烧灼术及电凝术均能施行有效热凝治疗,为最迅速和可靠的止血方法之一;⑤嗅裂筛顶部动脉出血点适宜用可吸收性止血材料微创填塞法治疗;⑥动脉性鼻出血好发于中老年人群,以男性为常见,常发生于鼻中隔前中部,即鼻腔动脉末梢部;⑦高血压病及动脉粥样硬化可能是动脉性鼻出血的主要原因,且与季节、吸烟和饮酒有一定关系。更多还原

【Abstract】 OBJECTIVE To explore the method and characteristics of micro-traumatic therapy for severe superficial or deep-seated intractable arterial epistaxis(IAE). METHODS Under nasal endoscopic monitoring, electric heat cauterization(EHC), high frequency electric coagulation(HFEC), microwave coagulation(MC) and micro-traumatic nasal packing(MTNP) were applied respectively for management of severe superficial or deep-seated IAE in 487 patients. RESULTS EHC was applied on 327 patients with superficial IAE and all the patients got successful outcome. MC was applied on 135 with superficial IAE and bleeding was not successfully stopped in 40 cases with active hemorrhagic state. They were successfully treated later by EHC. While the HFEC was applied on 15 patients with postnasal IAE and the olfactory fissura area MTNP was applied on 10 patients with sieve roof IAE and all the cases got successful outcome. All the cases were followed up for 4 weeks and no bleeding occurred in the former location with any of the 4 methods. CONCLUSION ①The lateral or posterior area of middle and inferior nasal meatus as well as olfactory fissura area are the usually sites of intractable epistaxis. ②Under nasal endoscopic micro-traumatic therapy is a reliable, convenient and effective method for IAE. ③MC is not indicated for active IAE. ④For static or active bleeding, EHC and HFEC are able to provide an effective heat coagulation therapy, which are the quickest and most reliable way to obtain hemostasis. ⑤IAE in the roof of olfactory fissura is indicated for MTNP with soluble hemostatic material. ⑥Severe IAE most frequently met in middle age and aged male population and often seen in anterior part of nasal septum, i.e. frequently encounteredin the terminal part of nasal artery. ⑦Hypertension and arteriosclerosis are possibly the main causes of IAE. Season, smoking and drinking may have some relation toIAE.更多还原