血管内栓塞治疗在神经内镜经鼻蝶入路术后难治性鼻出血治疗中的应用效果  

Application effect of endovascular embolization in the treatment of intractable epistaxis after transsphenoidal endoscopic surgery

作　　者：范国锋 程鹏 文渊丰 房泰鞍 杜郭佳[1] Fan Guofeng;Cheng Peng;Wen Yuanfeng;Fang Taian;Du Guojia(Department of Neurosurgery,the First Afiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院神经外科,乌鲁木齐830054

出　　处：《中华神经外科杂志》2024年第11期1142-1147,共6页Chinese Journal of Neurosurgery

基　　金：新疆维吾尔自治区自然科学基金杰出青年项目(2022D01E75);新疆维吾尔自治区自然科学基金青年项目(2022D01C257)。

摘　　要：目的探讨血管内栓塞技术在神经内镜经鼻蝶入路术后难治性鼻出血治疗中的应用效果。方法回顾性分析2015年1月至2022年5月在新疆医科大学第一附属医院神经外科接受血管内栓塞治疗的21例经鼻蝶内镜术后难治性鼻出血患者的临床资料。术后评价及判定患者出血情况及相关并发症。术后通过电话或门诊随访患者有无复发。结果 21例患者均行全脑数字减影血管造影术, 其中2例患者造影结果阴性, 造影阳性率达90.5%(19/21)。根据造影结果, 14例双侧鼻黏膜染色异常患者及造影阴性患者均行双侧颌内动脉远端分支血管内栓塞治疗予以止血, 4例单侧鼻黏膜染色异常患者行单侧颌内动脉远端分支栓塞治疗, 1例颈内动脉假性动脉瘤患者行覆膜支架置入治疗。术后21例患者鼻出血症状均完全好转, 治疗效果良好。其中8例(38.1%)出现颌面部疼痛, 4例(19.1%)出现牙痛, 2例(9.5%)出现面部麻木, 7例(33.3%)无明显并发症。21例患者的随访时间为(4.10±2.05)个月(1~10个月)。至末次随访, 无一例患者出现鼻出血复发。结论血管内栓塞治疗在神经内镜经鼻蝶入路术后难治性鼻出血治疗中安全且有效率高。Objective To investigate the application value of neurointerventional technique in the treatment of refractory epistaxis after transsphenoidal endoscopic surgery.Methods A retrospective analysis was conducted on the clinical data of 21 patients with refractory epistaxis after transsphenoidal endoscopic surgery who underwent endovascular interventional embolization at Department of Neurosurgery,the First Affiliated Hospital of Xinjiang Medical University from January 2015 to May 2022.Postoperative bleeding and related complications were evaluated and determined.Patients were followed up by telephone or outpatient examination for recurrence.Results All the 21 patients underwent successful cerebral angiography,and 2 cases were negtive,the positive rate was 90.5%(19/21).According to the results of angiography,14 patients with bilateral abnormal mucosal staining underwent interventional embolization of bilateral distal branches of internal maxillary artery for hemostasis,4 patients with unilateral abnormal mucosal staining underwent interventional embolization of unilateral distal branches of internal maxillary artery,and 1 patient with internal carotid artery pseudoaneurysm underwent covered stent placement.After the operation,the symptoms of epistaxis in 21 patients were completely improved,and the treatment effect was good.Among them,8 cases(38.1%)had maxillofacial pain,4 cases(19.1%)had toothache,2 cases(9.5%)had facial numbness,and 7 cases(33.3%)had no obvious complications.The follow-up time of 21 patients was 4.10±2.05 months(1-10 months).At the last follow-up,no recurrence of epistaxis was identified.Conclusion Interventional embolization is safe and effective for the treatment of refractory epistaxis after transsphenoidal endoscopic surgery,which has high clinical application value.

关 键 词：鼻出血 自然腔道内镜手术 血管内操作 栓塞 治疗性 手术后并发症 

分 类 号：R651[医药卫生—外科学]