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中华介入放射学电子杂志 ›› 2018, Vol. 06 ›› Issue (01) : 14 -17. doi: 10.3877/cma.j.issn.2095-5782.2018.01.004

所属专题: 文献

专题研究·急诊介入

介入栓塞治疗难治性鼻出血的疗效分析
王斌1, 刘圣1,(), 刘兴龙1, 祖庆泉1, 赵林波1, 施海彬1   
  1. 1. 210029 南京医科大学第一附属医院(江苏省人民医院)介入科
  • 收稿日期:2018-01-02 出版日期:2018-02-01
  • 通信作者: 刘圣

Therapeutic efficacy of transarterial embolization in treatment of intractable epistaxis

Bin Wang1, Sheng Liu1,(), Xinglong Liu1, Qingquan Zu1, Linbo Zhao1, Haibin Shi1   

  1. 1. Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
  • Received:2018-01-02 Published:2018-02-01
  • Corresponding author: Sheng Liu
  • About author:
    Corresponding author: Liu Sheng, Email:
引用本文:

王斌, 刘圣, 刘兴龙, 祖庆泉, 赵林波, 施海彬. 介入栓塞治疗难治性鼻出血的疗效分析[J/OL]. 中华介入放射学电子杂志, 2018, 06(01): 14-17.

Bin Wang, Sheng Liu, Xinglong Liu, Qingquan Zu, Linbo Zhao, Haibin Shi. Therapeutic efficacy of transarterial embolization in treatment of intractable epistaxis[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2018, 06(01): 14-17.

目的:

研究介入栓塞治疗难治性鼻出血的造影表现及临床疗效。

方法:

回顾性分析2009年1月—2017年9月在我科接受介入治疗的59例难治性鼻出血患者的临床资料。59例患者按病因分为良性40例、恶性19例。按造影结果分阳性45例,阴性14例,根据病因与造影结果分类评价介入治疗难治性鼻出血的止血效果与复发情况。

结果:

所有59例患者均成功行血管造影术,其中58例成功进行介入栓塞止血,1例造影后因颈内动脉假性动脉瘤破裂出血死亡。良性患者的造影阳性率(29/40,72.5%)与恶性患者的造影阳性率(16/19,84.2%)差异无统计学意义(χ2=0.436,P=0.509)。良性患者组的复发率(2/40,5.0%)与恶性患者组(4/18,22.2%)差异无统计学意义(P=0.068)。造影阳性组的复发率(4/44,9.1%)与造影阴性组的复发率(2/14,14.3%)差异无统计学意义(P=0.624)。

结论:

介入治疗难治性鼻出血安全有效;对于造影阴性的患者,经验性栓塞双侧上颌动脉远端分支能够有效止血。

Objective:

To investigate the angiographic manifestation and evaluate the safety and efficacy of transarterial embolization (TAE) for intractable epistaxis.

Methods:

From January 2009 to September 2017, the clinical data of 59 patients with intractable bleeding undergoing TAE in our department were reviewed. All cases were divided into 40 cases of benign group and 19 cases of malignant group. According to angiographic findings, the patients were divided into 45 cases of positive group and 14 cases of negative group. The outcomes of interventional therapy were assessed according to different causes of disease (malignant or benign disease) and angiographic finding (positive or negative angiogram) .

Results:

All the 59 patients recieved diagnostic angiography. Bleeding was controlled successfully in 58 patients after embolization except 1 patient who died of rupture of ICA pseudoaneurysm. Positive angiographic findings were found in 29 of 40 cases (72.5%) with benign diseases and 16 of 19 cases (84.2%) with malignant diseases, respectively, there was no significant difference between them (χ2=0.436, P=0.509) . There was no significant difference in recurrence rates between patients with benign diseases (2/40, 5.0%) and malignant diseases (4/18, 22.2%) (P=0.068) . No significant difference was found in recurrence rates between patients with positive (4/44, 9.1%) and negative angiography (2/14, 14.3%) (P=0.624) .

Conclusions:

TAE appears to be a safe and effective treatment for patients with intractable epistaxis. For patients with negative angiographic finding, bilateral IMA embolization is an effective method.

图1 典型病例(男性,23岁,外伤后鼻出血)栓塞前后造影表现
[1]
Strach K, Schröck A, Kai W, et al. Endovascular treatment of epistaxis: indications, management, and outcome[J]. Cardiovasc Intervent Radiol, 2011, 34(6):1190-1198.
[2]
金新,王君影,顾东生,等.颈外动脉结扎术治疗顽固性鼻出血24例报告[J].南京医科大学学报(自然科学版),2013,33(1):146-148.
[3]
Gottumukkala R, Kadkhodayan Y, Moran CJ, et al. Impact of vessel choice on outcomes of polyvinyl alcohol embolization for intractable idiopathic epistaxis[J]. J Vasc Interv Radiol, 2013, 24(2):234-239.
[4]
Zhang CW, Xie XD, You C, et al. Endovascular treatment of traumatic pseudoaneurysm presenting as intractable epistaxis[J]. Korean Journal of Radiology, 2010, 11(6):603-611.
[5]
Risley J, Mann K, Jones NS. The role of embolisation in ENT: an update[J]. J Laryngol Otol, 2012, 126(3):228-235.
[6]
Lam JW, Chan JY, Lui WM, et al. Management of pseudoaneurysms of the internal carotid artery in postirradiated nasopharyngeal carcinoma patients[J]. Laryngoscope, 2014, 124(10):2292-2296.
[7]
Bachar G, Esmat N, Stern S, et al. Transarterial embolization for acute head and neck bleeding: Eight-year experience with emphasis on rebleeding risk in cancer patients[J]. Laryngoscope, 2013, 123(5):1220-1226.
[8]
Wong GK, Chan KK, Yu SC, et al. Treatment of profuse epistaxis in patients irradiated for nasopharyngeal carcinoma[J]. ANZ J Surg, 2007, 77(4):270-274.
[9]
刘明波,武文明,王嘉陵,等.头颈部肿瘤术后大动脉破裂出血的救治[J].中华耳鼻咽喉头颈外科杂志,2010,45(5):410-413.
[10]
Shah H, Gemmete JJ, Chaudhary N, et al. Acute life-threatening hemorrhage in patients with head and neck cancer presenting with carotid blowout syndrome: follow-up results after initial hemostasis with covered-stent placement[J]. AJNR Am J Neuroradiol, 2011, 32(4):743-747.
[11]
Seidel DU, Remmert S, Brassel F, et al. Superselective microcoil embolization in severe intractable epistaxis: an analysis of 12 consecutive cases from an otorhinolaryngologic and an interventional neuroradiologic point of view[J]. Eur Arch Otorhinolaryngol, 2015, 272(11):3317-3326.
[12]
Ballah D, Rabinowitz D, Vossough A, et al. Preoperative angiography and external carotid artery embolization of juvenile nasopharyngeal angiofibromas in a tertiary referral paediatric centre[J]. Clin Radiol, 2013, 68(11):1097-1106.
[13]
梁熙虹,郭鹏德,丁宁,等.颈内动脉栓塞在头颈部相关疾病治疗中的临床应用[J].中华医学杂志,2015,95(30):2442-2446.
[14]
罗中华,张虎,宫卫东,等.血管内治疗顽固性鼻出血:栓塞血管数目对疗效的影响[J].实用放射学杂志,2016,32(11):1769-1772.
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