介入栓塞治疗难治性头颈部出血的疗效研究  

Transcatheter arterial embolization for management of intractable bleeding in head and neck

作　　者：王斌[1] 刘圣[1] 祖庆泉[1] 赵林波[1] 刘兴龙[1] 周春高[1] 夏金国[1] 施海彬[1] 

机构地区：[1]南京医科大学第一附属医院介入放射科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2016年第5期606-609,共4页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省博士后科研资助(1102046C)

摘　　要：目的:分析难治性头颈部出血的造影特征并评价介入栓塞治疗的安全性及有效性。方法:2009年1月—2015年3月,48例难治性头颈部出血患者在本院接受介入栓塞治疗。回顾性分析其临床资料,根据良恶性病因、造影的阳性和阴性结果等指标,分类评价介入栓塞治疗难治性头颈部出血的有效性及并发症情况。结果:48例患者中恶性病变15例,良性病变33例;造影阳性36例,造影阴性12例,恶性病变与良性病变造影阳性率无统计学差异(P=0.106)。12例造影阴性患者中特发性鼻出血占8例,其余病因者4例,特发性鼻出血造影阴性率高于其余病因(P=0.001)。46例患者成功止血,1例术后出现视野缺损并发症,5例复发,恶性病变组与良性病变组或造影阳性组与阴性组之间出血复发率无统计学差异(P=0.339和P=0.785)。结论:介入栓塞治疗难治性头颈部出血安全有效;特发性鼻出血患者造影阴性率高,进行双侧蝶腭动脉经验性栓塞同样有较好的止血效果。Objective：To retrospectively study the angiographic findings of intractable bleeding in head and neck,and evaluate the safety and effectiveness of transcatheter arterial embolization（TAE） for these patients. Methods： Forty-eight patients underwent TAE for intractable bleeding in head and neck from January 2009 to March 2015. Through analyzing medical history and angiographic features of these patients,effectiveness and complications were evaluated according to etiologies and angiographic findings,respectively. Results： The 48 patients included 15 cases of malignant head and heck tumor and 33 cases of benign diseases. There were 36 cases presenting with positive angiographic findings and 12 cases with negative findings. There were no significant difference on positive angiography rate between malignant diseases and benign diseases（P =0.106）. Of the cases with negative findings there were 8 patients with idiopathic epistaxis and 4 patients with other diseases. The negative angiography rate of idiopathic epistaxis was higher than that of other diseases（P=0.001）. Forty-six patients achieved hemostasis. Recurrence occurred in 5 patients. One patient developed visual defect after embolization. No significant differences were found in recurrence rates between malignant and benign diseases or between positive and negative angiographic findings（P=0.339,P=0.785,respectively）. Conclusion： TAE is safe and useful for intractable bleeding in head and neck. Patients with idiopathic epistaxis are prone to present with negative angiographic finding. It seems effective for patients with epistaxis presenting with negative angiograms to receive prophylactic bilateral sphenopalatine artery embolization.

关 键 词：头颈部 出血 造影 栓塞 

分 类 号：R815[医药卫生—放射医学]