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目的 :探讨功能性内窥镜鼻窦手术 (FESS)出血的相关因素及预防措施。方法 :对 144例实施FESS ,对患者术中出血量及相关因素进行统计学分析。结果 :144例中出血量为 2 0～ 70 0ml,其中 2 0ml～ 2例(14 6 % ) ,50ml～ 4 7例 (32 6 % ) ,10 0ml～ 54例 (37 5% ) 2 0 0ml～ 18例 (12 5% ) ,50 0ml～ 4例 (2 8% )。术中易损伤的血管是筛前动脉及筛后动脉 ,蝶腭动脉和鼻后中隔动脉 ,颈内动脉。多次手术的患者因瘢痕组织中血管失去弹性和病变处血管异常增生是术中出血的重要因素。手术全麻和手术时间长可增加出血。结论 :为减少FESS术中出血 ,术者须熟悉鼻窦解剂学 ,术前仔细阅读CT片 ,了解病变范围及解剖学变异。术中要清楚每一步操作处的解剖位置 ,仔细辩认术区的重要血管并加以保护 ,术前常规使用 1%肾上腺素收敛鼻黏膜血管可减少术中出血
Objective: To explore the related factors and preventive measures of functional endoscopic sinus surgery (FESS) bleeding. Methods: FESS was performed in 144 cases, and the amount of intraoperative blood loss and related factors were statistically analyzed. Results: The amount of hemorrhage in 144 cases was 20-70ml, of which 20ml ~ 2 cases (14.6%), 50ml ~ 47 cases (32.6%), 100ml ~ 54 cases (37.5%) 200ml ~ 18 cases (125%), 50ml ~ 4 cases (28%). Vulnerable intraoperative blood vessels are the anterior ethmoidal artery and posterolateral arteries, sphenopalatine artery and nasal septum artery, internal carotid artery. Multiple surgical patients due to scar tissue loss of vascular elasticity and abnormal vascular dysplasia is an important factor in intraoperative bleeding. General anesthesia and surgery for a long time can increase bleeding. Conclusion: In order to reduce intraoperative bleeding in FESS, surgeons must be familiar with sinus debridement. Read the CT pictures preoperatively to understand the extent of the lesion and the anatomic variation. Intraoperative surgery to clearly understand the anatomical location of each step, carefully identify the important blood vessels in the surgical area and to be protected, preoperative routine use of 1% epinephrine convergence of nasal mucosal blood vessels can reduce intraoperative bleeding