下鼻道后穹窿鼻出血的临床特点及综合治疗

发布时间：2018-08-01 09:17

【摘要】：目的:总结下鼻道后穹窿鼻出血的临床特点并分析其综合治疗措施。方法:212例鼻出血住院患者中23例(10.8%)确诊为下鼻道后穹窿鼻出血,1例在全身麻醉下行鼻内镜鼻腔探查+电凝止血术,其余22例在局部麻醉下行鼻腔探查+电凝止血术。所有患者在术中排除了嗅裂、蝶筛隐窝及中鼻道出血,术中行下鼻甲骨折内移位后见下鼻道后穹窿活动性出血,立即给予双极电凝止血。术后电凝区域及鼻黏膜糜烂处填塞少量纳吸棉组织。结果:所有患者术中均发现明确的出血点并成功止血;术后1周内未再出血。随访6~12个月患侧鼻腔无再发鼻出血,无鼻腔粘连。结论:难治性鼻出血如排除嗅裂、蝶筛隐窝及中鼻道出血,则应考虑下鼻道后穹窿出血的可能。术中将下鼻甲往内侧骨折移位彻底暴露下鼻道后穹窿并仔细探查是发现和治疗下鼻道后穹窿鼻出血的关键。
[Abstract]:Objective: to summarize the clinical features of posterior fornix epistaxis and analyze its comprehensive treatment. Methods among 212 inpatients with epistaxis, 23 (10.8%) were diagnosed as posterior fornix epistaxis. 1 case underwent endoscopic nasal coagulation hemostasis under general anesthesia, and the remaining 22 cases underwent rhinoconstriction hemostasis under local anesthesia. All the patients were excluded from olfactory fissure, sphenoethmoid recess and middle nasal canal hemorrhage during the operation. After internal displacement of inferior turbinate fracture, active hemorrhage of posterior fornix of inferior nasal canal was observed, and bipolar electric coagulation was given immediately to hemostasis. After operation, a small amount of cotton absorption tissue was filled in the area of electrocoagulation and nasal mucosal erosion. Results: all the patients had a definite bleeding point during operation and stopped bleeding successfully, and no further bleeding occurred within 1 week after operation. No recurrent epistaxis and no nasal adhesions were observed in 6 ~ 12 months. Conclusion: the possibility of posterior fornix hemorrhage of the inferior nasal canal should be considered if the intractable epistaxis is excluded from olfactory fissure, sphenoethmoid recess and middle nasal canal hemorrhage. Displacement of the medial inferior turbinate fracture and thorough exploration of the posterior fornix of the inferior nasal canal are the key to the discovery and treatment of posterior fornix epistaxis of the inferior nasal canal.
【作者单位】：武汉大学人民医院耳鼻咽喉头颈外科;
【分类号】：R765.23

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