咽喉部手术大出血的救治体会  

Experience in the emergency treatment of post-operative massive hemorrhage following pharyngeal surgery

作　　者：王大明[1] 刘业海[1] 吴静[1] WANG Daming;LIU Yehai;WU Jing(Department of Otolaryngology-Head&Neck Surgery,The First Affiliated Hospital of Anhui Medical University,230022,China)

机构地区：[1]安徽医科大学第一附属医院耳鼻咽喉头颈外科,合肥230022

出　　处：《中国中西医结合耳鼻咽喉科杂志》2024年第5期367-369,324,共4页Chinese Journal of Otorhinolaryngology in Integrative Medicine

基　　金：安徽医科大学第一附属医院首批“登峰计划”学科建设项目(院科〔2019〕22号)。

摘　　要：目的总结咽喉部手术后大出血的处理对策及救治体会。方法对2018年1月~2022年5月我院收治的11例咽喉部手术后大出血患者进行回顾性分析,总处理方法和经验。本组病中,7例为腭咽成形术后大出血,其中2例在局麻下电凝止血,2例在全麻下电凝后缝扎止血,另外3例采取舌骨上入路止血,预防性气管切开;3例会厌术后大出血,予以舌骨上入路止血,预防性气管切开;1例喉咽癌术后大出血,立即予以更换带气囊气管套管全麻行支撑喉镜下电凝止血,凡士林碘仿纱条填塞压迫3d后取出。结果11例患者经有效治疗均抢救成功,预后良好,出院后随访1个月未再出血。预防性气管切开患者术后3天至1个月全部拔除气管套管。结论咽喉部手术后出血为耳鼻咽喉头颈外科的严重急症之一,根据患者病情采取及时有效的处理方案可取得良好的救治效果。Objective To report the clinical experience in the emergency treatment of post-operative massive hemorrhage following pharyngeal surgery.Methods A retrospective analysis was carried out among 11 cases with post-operative massive hemorrhage following pharyngeal surgery,who had been treated in our hospital from Jan.2018 to May 2022,to report our experience in this field.Among these patients,7 suffered from massive hemorrhage after velopharyngoplasty,with 2 cases out of them received electrocoagulation under local anesthesia to stop bleeding,2 received electrocoagulation followed suturing under general anesthesia for hemostasis,and the other 3 received an operation of suprahyoid approach plus preventive tracheostomy for stopping post-operative bleeding.In this group of cases,there were 3 cases with post-operative massive hemorrhage following epiglottic surgery were treated by an operation of suprahyoid approach plus preventive tracheostomy for stopping post-operative bleeding as well,while another case with post-operative massive hemorrhage following laryngopharyngeal carcinoma surgery was immediately replaced a balloon tracheal tube under general anesthesia,and then,electrocoagulation was used to stop bleeding under a support laryngoscope,with vaseline-iodoform gauze compressed for three days to stop bleeding.Results All these 11 patients were successfully rescued after effective treatment with good prognosis.During the following up period lasted for one month,there was no further bleeding occurred in any cases.For those patients with preventive tracheotomy,all the tracheal tubes were removed from 3 days to 1 month after the surgery.Conclusion Post-operative massive bleeding following pharyngeal surgery is one of the serious emergencies in the field of otolaryngology head and neck surgery in clinical practice.Good treating results can be achieved by taking timely and effective treatment procedures according to patient's individual situation.

关 键 词：咽喉手术 术后大出血 急救处理 临床经验 

分 类 号：R762[医药卫生—耳鼻咽喉科]