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目的探讨经导管动脉栓塞治疗难治性及威胁生命的鼻出血的疗效及并发症的防治策略。资料与方法回顾性分析2001至2008年期间59例难治性及威胁生命的鼻出血患者资料,经常规后鼻腔填塞、药物治疗等措施无效后,在DSA下明确出血靶动脉后选择适当栓塞材料栓塞出血靶动脉,随访1～30天,观察栓塞疗效及并发症情况。结果59例鼻出血患者除1例因主动脉及左颈总动脉非常迂曲,导管无法进入,未行栓塞;1例因失血性休克在造影中死亡而未行栓塞;1例颈内动脉段巨大假性动脉瘤结合外科手术外;余56例均成功完成血管内栓塞治疗,技术成功率为94.9%(56/59),37例栓塞后活动性出血停止,18例栓塞术后1周内仍有少量出血,后结合内科治疗,出血停止,栓塞有效率98.2%(55/56),1例栓塞后1个月再次出血,第二次栓塞后随访1个月未复发。29例栓塞后无并发症出现,23例术后出现头痛,低热,颌面部麻木、张口受限等轻度并发症,1例术后头痛剧烈、头面部数处表皮坏死,3例术后出现脑栓塞导致相应肢体偏瘫。结论对于难治性及威胁生命鼻出血,血管内栓塞目前已成为有效而安全的治疗方法。栓塞后可能出现栓塞后综合征及局部缺血症状,严重者可有局部坏死出现,最严重者可有颈内系统的误栓,导致脑栓塞。因此根据原发病因制定适当治疗方案、术中超选择插管、合理选择栓塞剂及栓塞方法是减少并发症的关键。
Objective To investigate the efficacy and complications of transcatheter arterial embolization in refractory and life-threatening nasal hemorrhage. Materials and Methods Retrospective analysis of 59 refractory and life-threatening patients with epistaxis during 2001-2008 retrospectively analyzed the data of patients with nasal bleeding after routine post-nasal packing and drug treatment, Embolization of the target artery bleeding, followed up for 1 to 30 days to observe the efficacy and complications of embolism. Results In 59 cases of epistaxis patients, 1 case had tortuous aorta and left common carotid artery, the catheter was unable to enter and did not embolize; 1 case died of hemorrhagic shock in angiography without embolization; 1 case had huge internal carotid artery segment Pseudoaneurysm combined with surgery; more than 56 cases were successfully completed endovascular embolization, the technical success rate was 94.9% (56/59), 37 cases of active bleeding stopped after embolization, 18 cases within 1 week after embolization A small amount of bleeding, combined with medical treatment, bleeding stopped, embolization efficiency was 98.2% (55/56), 1 case of re-bleeding one month after embolization, the second embolization did not relapse after a follow-up of 1 month. Twenty-nine patients had no complications after embolization. Twenty-three patients had mild complications such as headache, fever, maxillofacial numbness and limited mouth opening. One patient had severe headache and epidermal necrosis after operation, and three patients showed postoperative epidural necrosis Cerebral embolism leads to hemiplegia of the corresponding limb. Conclusion For intractable and life-threatening nosebleeds, endovascular embolization has now become an effective and safe treatment. After embolism may appear post-embolic syndrome and ischemic symptoms, severe cases may have localized necrosis, the most serious may have misuse of the internal carotid system, resulting in cerebral embolism. Therefore, according to the primary cause of the development of appropriate treatment options, intraoperative super selection intubation, a reasonable choice of embolic agents and embolization method is the key to reducing complications.