血管内栓塞治疗口鼻腔大出血  

Endovascular embolization for the management of oronasal cavity hemorrhage

作　　者：张猛[1,2] 朱晓黎[1] 刘一之[1] 倪才方[1] 金泳海[1] 邹建伟[1] 陈珑[1] 

机构地区：[1]苏州大学附属第一医院介入放射科,江苏215006 [2]无锡市第三人民医院

出　　处：《介入放射学杂志》2017年第5期403-407,共5页Journal of Interventional Radiology

摘　　要：目的评价经导管动脉栓塞术(TAE)治疗口鼻腔大出血的效果、并发症发生及预防。方法回顾2005年11月至2013年10月经治的121例难治性及致命性口鼻腔大出血患者临床资料。对116例接受TAE术治疗患者分别进行1~3个月随访,了解栓塞效果及相关并发症发生情况。结果 116例患者中96例(82.7%)出血完全控制,19例(16.4%)1周内再次出血并经药物治疗得以控制,1例(0.9%)1周内再次出血接受二次栓塞治疗;77例(66.4%)无明显并发症发生,35例(30.1%)出现颌面部疼痛、麻木,低热,张口受限等轻度并发症,1例(0.9%)出现面部皮肤坏死及重度头痛,3例(2.6%)因脑栓塞出现卒中症状。结论根据不同病因及责任血管选择适宜栓塞材料,TAE术治疗难治性及致命性口鼻腔大出血可快速有效达到止血目的。术后常见并发症有栓塞后综合征、局部缺血、末梢循环缺血所致局部坏死,严重并发症主要为异位栓塞所致颌面部皮肤坏死、脑梗死。Objective To evaluate the efficacy of transcatheter arterial embolization （TAE） in treating oronasal cavity hemorrhage, and to discuss the the occurrence and prevention of complications. Methods The clinical data of 121 patients with refractor＇） and fatal oronasal cavity hemorrhage, who were admitted to authors＇ hospital during the period from December 2005 to October 2013 to receive treatment, were retrospectively analyzed. A total of 116 patients were treated with TAE, and these patients were followed up for 1-3 months to evaluate the embolization effect and the occurrence of procedure-related complications was analyzed. Results Of the 116 patients, complete control of bleeding after TAE was achieved in 96 （82.7%）, re- bleeding within one week after TAE was seen in 19 （16.4%） and the bleeding was controlled by medication, and in the remaining one （0.9%） re-bleeding occurred within one week after TAE and embolization therapy had to be carried out again. No obvious complications occurred in 77 patients （66.4%） ; maxillofacial pain and numbness, low fever, limitation of mouth opening and other mild complications were observed in 35 patients （30.1%）; one patient （0.9%） developed facial skin necrosis and severe headache; and 3 patients （2.6%） showed stroke symptoms due to cerebral embolism. Conclusion For the treatment of refractory and fatal oronasal cavity hemorrhage, TAE can quickly and effectively achieve the purpose of hemostasis; careful selection of proper embolization material based on the the different causes of bleeding and the responsible blood vessels is the key to ensure a successful TAE. The common postoperative complications include post- embolization syndrome, local ischemia, local necrosis caused by peripheral ischemia; the main serious complications are skin necrosis of maxillofacial region and cerebral infarction caused by ectopic embolization. （J Intervent Radiol, 2017, 26： 403-407）

关 键 词：口鼻腔出血 经导管动脉栓塞术 疗效 并发症 

分 类 号：R459.7[医药卫生—急诊医学]