头面部外伤后迟发性鼻出血16例诊治分析  

Diagnosis and Treatment of 16 Cases of Delayed Nosebleed after Head and Face Trauma

作　　者：任金英 REN Jin-ying(Department of Otolaryngology,People's Hospital of Lingcheng District,Dezhou,Shandong Province,253500 China)

机构地区：[1]山东省德州市陵城区人民医院耳鼻喉科

出　　处：《系统医学》2019年第20期38-40,共3页Systems Medicine

摘　　要：目的该文旨在研究头面部外伤后出现迟发性鼻出血这一临床表现的具体原因,对其进行诊断,并分析治疗方案。方法选择该院在2010年6月-2018年10月间接受救治的16例头面部外伤患者,采用DSA进行确诊,依据迟发性鼻出血、影像学以及随访的具体资料来分析出有效的治疗方案。结果自该院收治的16例头面部外伤的患者中,因颈内动脉处的海绵窦段的假性动脉瘤而导致的迟发性鼻出血的有13例,出血量达到60~900 mL,采用覆膜支架的术式进行治疗后,出现视野缺损的有2例,失明的有1例;因颌内动脉内分支部位的假性动脉瘤而导致的迟发性鼻出血的有3例,出血量在200mL左右,采用血管介入明胶栓塞的术式进行治疗,经DSA复查后诊断未有假性动脉瘤复发者。结论颈内海绵窦段与颌内假性动脉瘤都是头面部外伤后可引发迟发性鼻出血的原因,可根据MRA、DSA、CTA进行临床诊断,采用血管介入的术式可取得较理想的临床效果。Objective The purpose of this study was to investigate the clinical causes of delayed nosebleeds after head and face trauma,to diagnose them,and to analyze treatment options.Methods Sixteen patients with head and face trauma who were treated in our hospital from June 2010 to October 2018 were enrolled in the study.DSA was used to confirm the diagnosis.According to the specific data of delayed nosebleed,imaging and follow-up,effective treatment was analyzed.Results Of the 16 patients with head and face trauma who were admitted to the hospital,13 had delayed nosebleeds due to a pseudoaneurysm of the cavernous sinus at the internal carotid artery.The amount of bleeding reached 60-900 m L.After the treatment of the membrane stent,there were 2 cases with visual field defects,1 case with blindness,and 3 cases of delayed nosebleed due to pseudoaneurysms in the internal branch of the internal jaw artery about 200 m L,the treatment was performed with vascular interventional gelatin embolization,and no recurrence of pseudoaneurysm was diagnosed after DSA review.Conclusion Both the cervical cavernous sinus segment and the intramaxillary pseudoaneurysm can cause delayed nosebleed after head and face trauma.It can be diagnosed according to MRA,DSA and CTA.The ideal clinical effects of procedure of vascular intervention can be achieved.

关 键 词：头面部外伤 迟发性鼻出血原因 假性动脉瘤 覆膜支架 血管介入 

分 类 号：R765.9[医药卫生—耳鼻咽喉科] R651.15[医药卫生—临床医学]