鼻内镜下老年人顽固性鼻出血的微创治疗  

Microtraumatic treatment to the eldly with intractable epistaxis under nasal endoscope

作　　者：刘军[1] 马嵩[1] 谢为民[1] 

机构地区：[1]河南省人民医院耳鼻咽喉科

出　　处：《中国中西医结合耳鼻咽喉科杂志》2009年第2期92-94,共3页Chinese Journal of Otorhinolaryngology in Integrative Medicine

摘　　要：目的探讨鼻内镜下微创治疗老年人顽固性鼻出血的方法及适应证。方法对32例老年人顽固性鼻出血患者鼻内镜下检查，明确出血部位，使用铬酸局部烧灼、明胶海绵局部填塞止血，回顾性分析出血部位、疗效及治疗方法的选择。结果全部病例可见鼻腔黏膜多处糜烂，出血部位最多见于嗅裂鼻中隔部11例，鼻中隔棘或嵴7例，下鼻道顶部7例，中鼻道4例，中鼻甲后端2例，蝶筛隐窝1例；7例鼻中隔偏曲有棘或嵴致出血者，同期鼻内镜下行鼻中隔偏曲成形术。单独使用铬酸止血16例，单独使用明胶海绵止血7例，联合应用铬酸和明胶海绵止血9例。全部病例1次治愈30例，2次2例，随访3个月无复发。无严重并发症。结论鼻内镜下精确定位出血点是实施微创局部烧灼或填塞止血的关键。Objective To investigate the methods and indications ofmicrotraumatic treatment in the eldly with intractable epistaxis under nasal endoscope. Methods The bleeding points and surgical techniques as well as its effects were studied retrospectively in 32 cases,in whom the bleeding points were examined under nasal endoscope and chromate or gelfoam were used to stop the bleeding. Results Many erosion sites of nasal mucous membrane could be found in all patients. The bleeding points of 11 cases were in the nasal septum parallel to olfactory cleft, 7 in the nasal septum spine or crest, 7 in the superior wall of inferior nasal meatus, 4 in the middle nasal meatus, 2 in the posterior area of middle turbinate, and 1 in the sphenoethmoidal recess. The 7 patients with nasal septum spine or crest which leaded to hemorrhage were simultaneously received diorthosis under nasal endoscopy. Among all the 32 patients,16 received chromate hemostasis alone, 7 with gelfoam alone, and 9 with both. Among 32 cases, thirty cases were cured after one time of treatment and two cases were cured after 2 times. There were no reoccurrance in the following 3 months and no serious complications. Conclusions The key to perform microtraumatic treatment of epistaxis was to locate the bleeding point correctly.

关 键 词：鼻内镜 老年 微创治疗 鼻出血 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]