鼻出血血管内栓塞治疗后短期复发的原因与对策  

Recurrent epistaxis occurred shortly after superselective embolization of external carotid artery: its causes and prevention strategy

作　　者：曾晓华[1] 邱怀明[1] 陈志辉[1] 易翠容[1] 袁远[1] 

机构地区：[1]广州军区武汉总医院放射科,武汉430070

出　　处：《介入放射学杂志》2011年第8期645-648,共4页Journal of Interventional Radiology

摘　　要：目的分析重症鼻出血患者行颈外动脉栓塞治疗后短期复发的原因,并探讨预防措施。方法 62例重症鼻出血患者,其中16例行栓塞治疗后2周内复发,第1周内鼻出血复发9例,第2周鼻出血复发7例,均再行选择性动脉造影并行栓塞治疗,复习所有病例首次造影及栓塞经过,分析鼻出血复发原因。结果再次造影显示原栓塞之颈外动脉分支再通、致鼻出血复发10例;病变由颈外动脉多支供血,但首次血管内介入治疗时遗漏供血动脉支致鼻出血复发4例;病变侧支循环供血建立致鼻出血复发2例。结论造影全面观察并彻底栓塞鼻出血供血动脉支、以不可吸收性栓塞微粒完全填闭病变血管床可避免鼻出血复发。Objective To discuss the causes of recurrent epistaxis occurred shortly after superselective embolization of external carotid artery and to make some suggestions related to the prevention strategy. Methods Superselective embolization of external carotid artery was carried out in 62 patients with severe epistaxis. Recurrence occurred in 9 cases within one week and in 7 cases within two weeks after the treatment. And the selective angiography together with the embolization therapy was performed again. The initial angiograms and the detailed embolization procedures were carefully reviewed and the possible causes of epistaxis recurrence were analyzed. Results In 10 patients the recurrent epistaxis was caused by recanalization of the branches of external carotid artery. The lesions were fed by multiple branches of external carotid artery, but in 4 cases some of them were missed to be occluded in initial embolization procedure, resulting in recurrent epistaxis. In another two cases the recurrent epistaxis was caused by the establishment of collateral blood supply to the lesions. Conclusion Careful observation of angiograms to find out all feeding arteries to the lesion and complete embolization of all feeding arteries with un-absorbable embolic agents can avoid the recurrence of epistaxis.

关 键 词：鼻出血 造影 栓塞 

分 类 号：R765.23[医药卫生—耳鼻咽喉科]