儿童扁桃体术后反复出血介入治疗成功1例  

A successful interventional treatment of recurrent bleeding after tonsil surgery in children

作　　者：赵媛 朱晶 魏苗 赵昱 ZHAO Yuan;ZHU Jing;WEI Miao;ZHAO Yu(Department of Otolaryngology Head and Neck Surgery,Xi'an Children's Hospital,Xi'an,710003,China)

机构地区：[1]西安市儿童医院耳鼻咽喉头颈外科,西安710003

出　　处：《临床耳鼻咽喉头颈外科杂志》2025年第3期272-275,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：患儿,男,10岁4个月,以“扁桃体术后19 d,反复呕血11 d”入院。19 d前外院行内镜下双侧扁桃体+腺样体等离子融切、双侧扁桃体窝下极缝合术,11 d前出现反复呕血,伴一过性乏力及腹痛,诊断:①呕血待查:扁桃体术后出血?上消化道出血?;②急性中度失血性贫血。入院第1、3天,患儿2次突发大量呕血,均>1000 mL,唇面色苍白,乏力,失血性休克。出血迅猛,可自行终止,急诊检查不能窥见明确出血点,双侧扁桃体窝下极缝线在位。急诊行消化内镜未见明显异常,扁桃体、腺样体术区未探及明显出血点,颈部CT血管造影未见明显异常。急诊DSA引导下经皮选择性颈外动脉介入治疗术,术中见面动脉起始部约5 mm造影剂外溢,植入弹簧圈栓塞。术后患儿再未发生活动性出血,随访2个月生活如常。The patient,a 10-year-old and 4-month-old boy,was admitted to the hospital"with a history of 19 days since tonsil surgery and 11 days of recurrent hematemesis".19 days ago,bilateral endoscopic tonsil+adenoid plasma melting and bilateral tonsil fossa inferior pole suture were performed in the outer hospital,and recurrent hematemesis occurred 11 days ago,accompanied by transient fatigue and abdominal pain,diagnosis:①Hematemesis to be investigated:postoperative tonsil bleeding?Upper gastrointestinal bleeding?②Acute moderate hemorrhagic anemia.On the first and third days of admission,the child had two sudden episodes of massive hematemesis,both of which were more than 1000 mL,with pale lips,fatigue,and hemorrhagic shock.Bleeding was rapid and can terminate spontaneously,and emergency physical examination does not reveal a clear point of bleeding.Bilateral inferior pole sutures in the tonsillar fossa are in place.There were no obvious abnormalities in the emergency digestive endoscopy,no obvious bleeding points were detected in the tonsils and adenoids surgical area,and no obvious abnormalities were found in the neck CT angiography(CTA).Emergency DSA-guided percutaneous selective external carotid artery intervention was performed,during which about 5 mm contrast agent overflowed at the origin of the facial artery,and a coil was implanted.The child had no active bleeding after the operation,and his life was as usual at 2 months of follow-up.

关 键 词：扁桃体切除 手术并发症 动脉造影 介入栓塞术 

分 类 号：R766[医药卫生—耳鼻咽喉科]