CAJ | 학술논문

目的探讨内镜经鼻蝶窦入路术后迟发性鼻出血的临床特点及治疗方法.方法回顾性分析14例神经内镜经鼻蝶窦术后迟发性鼻出血患者的临床资料,分析该并发症的临床特征及治疗情况.结果本组术后迟发性鼻出血发生率为1.1％(14/1 224),术后7～15 d鼻出血者9例,术后≤2 d出血者2例,术后3～4周出血者3例,平均出血发生时间为术后10.3(2 ～25)d.14例中,鼻腔活动性渗血9例,鼻腔大出血4例,大出血合并休克及窒息者1例.13例为蝶腭动脉及其分支出血,1例为鼻前庭利特尔区出血.9例患者行内镜下经鼻蝶窦电凝止血,3例经鼻内镜下后鼻孔填塞止血,1例行鼻腔填塞止血.1例患者因鼻腔大出血发生窒息致呼吸骤停,心肺复苏后呈植物人状态.术后随访＞ 12个月,平均15.3个月,13例恢复良好,无再发性鼻出血发生,1例呈植物人状态者术后1个月因多器官功能衰竭死亡.结论迟发性鼻出血是内镜经鼻蝶窦入路手术的少见并发症,早期、及时、正确的个体化诊治可有效控制出血,预后相对好.
목적 탐토내경경비접두입로술후지발성비출혈적림상특점급치료방법.방법 회고성분석14례신경내경경비접두술후지발성비출혈환자적림상자료,분석해병발증적림상특정급치료정황.결과 본조술후지발성비출혈발생솔위1.1％(14/1 224),술후7～15 d비출혈자9례,술후≤2 d출혈자2례,술후3～4주출혈자3례,평균출혈발생시간위술후10.3(2 ～25)d.14례중,비강활동성삼혈9례,비강대출혈4례,대출혈합병휴극급질식자1례.13례위접악동맥급기분지출혈,1례위비전정리특이구출혈.9례환자행내경하경비접두전응지혈,3례경비내경하후비공전새지혈,1례행비강전새지혈.1례환자인비강대출혈발생질식치호흡취정,심폐복소후정식물인상태.술후수방＞ 12개월,평균15.3개월,13례회복량호,무재발성비출혈발생,1례정식물인상태자술후1개월인다기관공능쇠갈사망.결론 지발성비출혈시내경경비접두입로수술적소견병발증,조기、급시、정학적개체화진치가유효공제출혈,예후상대호.
Objective To investigate the clinical characteristics and treatment methods of delayed epistaxis after neuroendoscopic transnasal transsphenoidal surgery.Methods The clinical data of 14 patients with delayed epistaxis after neuroendoscopic transnasal transsphenoidal surgery were analyzed retrospectively.The clinical features and treatment of this complication were analyzed.Results The incidence of delayed epistaxis after procedure was 1.1％ (14/1 224) in this group.Nine patients had nasal bleeding from 7 to 15 d after procedure;2 had nasal bleeding at ≤2 d after procedure,and 3 had nasal bleeding from 3 to 4 weeks after procedure.The mean nasal bleeding time was 10.3 d after procedure.Of the 14 patients,9 had active and permeating bleeding in nasal cavity,4 had nasal hematorrhea,and 1 had nasal hematorrhea with shock and suffocation.Thirteen patients were sphenopalatine artery and its branch bleeding,and 1 was Littlehampton area bleeding.Nine patients used endoscopic surgery for electric coagulation hemostasis;3 received transnasal endoscopic lower posterior naris packing hemostasis;and 1 underwent nasal packing hemostasis.One patient had asphyxia and caused respiratory arrest because of nasal hematorrhea.He showed a persistent vegetative state after cardiopulmonary resuscitation.The patients were followed up for more than 12 months (mean 15.3 months).Thirteen patients recovered well and no recurrent epistaxis occurred,one died of multiple organ failure at one month after procedure.Conclusions Delayed epistaxis is a rare complication of endoscopic transsphenoidal surgery.Early,timely,and correct individualized diagnosis and treatment can effectively control epistaxis and the prognosis is good.