CAJ | 학술논문

目的探讨创伤性迟发性鼻出血的诊断和治疗方法,并提出创伤性颌面部中小动脉假性动脉瘤性鼻出血的概念.方法回顾性总结、分析了1990年3月-2005年3月期间山东省立医院耳鼻咽喉科收治的表现为创伤性迟发性鼻出血并接受数字减影血管造影检查和治疗的53例患者的有关资料.结果该53例患者中,颈内动脉假性动脉瘤8例,其中7例行血管栓塞治疗,6例痊愈,1例死亡;另1例未行栓塞,在行建立侧支循环功能训练时出血死亡;颈内动脉海绵窦瘘20例,均使用可脱性球囊栓塞成功;颌面部中小动脉出血25例,21例为上颌动脉和或面动脉分支出血,使用明胶海绵颗粒结合弹簧圈行血管栓塞治疗,4例筛前动脉出血者行筛前动脉结扎术.随访6～72个月,中位随访时间为5年.除1例上颌动脉栓塞者再次鼻出血外,其余患者随访期间均未再出血,未发生严重并发症.结论颈内动脉假性动脉瘤、颈内动脉海绵窦瘘、颌面部中小动脉假性动脉瘤性鼻出血是导致创伤性迟发性鼻出血主要原因,采用数字减影血管造影技术明确诊断并进行血管内栓塞或动脉结扎是治疗该类疾病的有效办法.
목적 탐토창상성지발성비출혈적진단화치료방법,병제출창상성합면부중소동맥가성동맥류성비출혈적개념.방법 회고성총결、분석료1990년3월-2005년3월기간산동성립의원이비인후과수치적표현위창상성지발성비출혈병접수수자감영혈관조영검사화치료적53례환자적유관자료.결과 해53례환자중,경내동맥가성동맥류8례,기중7례행혈관전새치료,6례전유,1례사망;령1례미행전새,재행건립측지순배공능훈련시출혈사망;경내동맥해면두루20례,균사용가탈성구낭전새성공;합면부중소동맥출혈25례,21례위상합동맥화혹면동맥분지출혈,사용명효해면과립결합탄황권행혈관전새치료,4례사전동맥출혈자행사전동맥결찰술.수방6～72개월,중위수방시간위5년.제1례상합동맥전새자재차비출혈외,기여환자수방기간균미재출혈,미발생엄중병발증.결론 경내동맥가성동맥류、경내동맥해면두루、합면부중소동맥가성동맥류성비출혈시도치창상성지발성비출혈주요원인,채용수자감영혈관조영기술명학진단병진행혈관내전새혹동맥결찰시치료해류질병적유효판법.
0bjective To explore the diagnosis and treatment of delayed traumatic epistaxis and put forward a concept of arteriola pseudoaneurysmal epistaxis originated from maxillofacial medium-sized artery.nethotis The clinical data of 53 patients who had the typical symptoms of delayed traumatic epistaxis and received digital subtraction angiography examination and treated in recent 10 years were retrospectively analyzed.Results Among the 53 patients,8 patients suffered from interal carotid artery pseudoaneurysm.For these 8 patients,1 died of massive epistaxis before embolization,7 received transcatheter arterial embolization(6 cured and 1 died).Twenty Patients suffered from traumatic carotid cavernous fistula.all were cured with endovascular occlusion by detachable baUoom Twenty-five patients suffered from maxillofacial artery hemorrhage.For these 25 patients,21 were treated by transcatheter artefial embolization with gelatin sponge and coils,4 by anterior ethmoidal artery ligation.The followed-up ranged from 6-72 months(median 5 years).All patients were successfully treated without serious complications and recurrent hemorrhage,except one patient who had recurred hemorrhage three weeks after transcatheter arterial embolization.This Patient was again successfully treated by artery ligation.Conclusions Interal carotid artery pseudoaneurysm,carotid cavernous fistula and maxillofacial medium-sized artery and arteriola pseudoaneurysm are the main causes of delayed traumatogenic epistaxis.Early diagnosis by digital subtraction angiography examination and transcatheter arterial embolization or artery ligation are the useful methods to treat delayed traumatic epistaxis and pseudoaneurysm.