神经内镜经鼻蝶窦入路术后迟发性鼻出血的临床分析  

Clinical analysis of delayed epistaxis after neuroendoscopic transnasal transsphenoidal surgery

作　　者：张红波[1] 陈谦学[3] 张亚卓[1] 宗绪毅[2] 王新生[2] 孙彦辉[1] 桂松柏[2] 李储忠[1] 白吉伟[2] 季玉陈[1] 穆林森[4] 

机构地区：[1]首都医科大学北京市神经外科研究所,100050 [2]首都医科大学附属北京天坛医院神经外科 [3]武汉大学人民医院神经外科 [4]广州市脑科医院神经外科

出　　处：《中华神经外科杂志》2015年第9期870-873,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨内镜经鼻蝶窦人路术后迟发性鼻出血的临床特点及治疗方法。方法回顾性分析14例神经内镜经鼻蝶窦术后迟发性鼻出血患者的临床资料，分析该并发症的临床特征及治疗情况。结果本组术后迟发性鼻出血发生率为1．1％（14／1224），术后7—15d鼻出血者9例，术后≤2d出血者2例，术后3～4周出血者3例，平均出血发生时间为术后10．3（2～25）d。14例中，鼻腔活动性渗血9例，鼻腔大出血4例，大出血合并休克及窒息者1例。13例为蝶腭动脉及其分支出血，1例为鼻前庭利特尔区出血。9例患者行内镜下经鼻蝶窦电凝止血，3例经鼻内镜下后鼻孔填塞止血，1例行鼻腔填塞止血。1例患者因鼻腔大出血发生窒息致呼吸骤停，心肺复苏后呈植物人状态。术后随访〉12个月，平均15．3个月，13例恢复良好，无再发性鼻出血发生，1例呈植物人状态者术后1个月因多器官功能衰竭死亡。结论迟发性鼻出血是内镜经鼻蝶窦入路手术的少见并发症，早期、及时、正确的个体化诊治可有效控制出血，预后相对好。Objective To investigate the clinical characteristics and treatment methods of delayed epistaxis after neuroendoscopic transnasal transsphenoidal surgery. Methods The clinical data of 14 patients with delayed epistaxis after neuroendoscopic transnasal transsphenoidal surgery were analyzed retrospectively. The clinical features and treatment of this complication were analyzed. Results The incidence of delayed epistaxis after procedure was 1.1% （14/1 224） in this group. Nine patients had nasal bleeding from 7 to 15 d after procedure; 2 had nasal bleeding at ≤2 d after procedure, and 3 had nasal bleeding from 3 to 4 weeks after procedure. The mean nasal bleeding time was 10. 3 d after procedure. Of the 14 patients, 9 had active and permeating bleeding in nasal cavity, 4 had nasal hematorrhea, and 1 had nasal hematorrhea with shock and suffocation. Thirteen patients were sphenopalatine artery and its branch bleeding, and 1 was Littlehampton area bleeding. Nine patients used endoscopic surgery for electric coagulation hemostasis; 3 received transnasal endoscopic lower posterior naris packing hemostasis; and 1 underwent nasal packing hemostasis. One patient had asphyxia and caused respiratory arrest because of nasal hematorrhea. He showed a persistent vegetative state after cardiopulmonary resuscitation. The patients were followed up for more than 12 months （mean 15.3 months）. Thirteen patients recovered well and no recurrent epistaxis occurred, one died of multiple organ failure at one month after procedure. Conclusions Delayed epistaxis is a rare complication of endoscopic transsphenoidal surgery. Early, timely, and correct individualized diagnosis and treatment can effectively control epistaxis and the prognosis is good.

关 键 词：神经内镜 手术后出血 迟发性鼻出血 经鼻蝶窦入路 

分 类 号：R651.1[医药卫生—外科学]