鼻内镜下彭氏电刀治疗难治性鼻出血的疗效观察
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摘要
目的探讨鼻内镜下彭氏电刀电凝治疗难治性鼻出血的方法及疗效。方法回顾性分析2013年12月～2017年12月因难治性鼻出血住院并行鼻内镜检查明确鼻出血的患者120例,均采用鼻内镜监视下彭氏电刀电凝止血,结合明胶海绵局部微填塞,术后随诊3个月,观察治疗效果。结果一次性治愈80例,二次治愈16例,6例因鼻中隔重度偏曲,经行鼻中隔成形术后治愈,所有患者均无心脑血管意外、鼻中隔穿孔、鼻腔粘连等并发症发生。结论鼻内镜检查能准确查找难治性鼻出血的出血部位,鼻内镜辅助下彭氏电刀电凝治疗鼻出血疗效确切,安全有效,其治愈率高,并发症少,患者痛苦小,尤其适用于有全身疾病的老年患者,值得临床推广。
Objective To explore the method and effect of Peng's electrocoagulation under nasal endoscope in the treatment of intractable epistaxis.Methods A retrospective analysis was performed on 120 patients with intractable epistaxis confirmed by nasal endoscopy, and admitted to the hospital from December 2013 to December 2017. All the 120 patients underwent electrocoagulation and hemostasis with peng's electric knife under nasal endoscopic surveillance, combined with local microtamponade with gelatin sponge. The therapeutic effect was observed by postoperative follow up of 3 months.Results 80 cases were cured after once treatment, 16 cases were cured after twice treatment, and 6 cases were cured after nasal septum plasty due to severe deviation of nasal septum. All patients had not complications such as cardio-cerebrovascular accident, perforation of nasal septum and nasal adhesion.Conclusion Nasal endoscopy examination can accurately locate the bleeding site of refractory epistaxis. Peng's electrocoagulation assisted by nasal endoscopy is effective and safe in the treatment of epistaxis. It has a high cure rate, fewer complications and less pain, especially suitable for elderly patients with systemic diseases. It is worthy of clinical promotion.
Objective To explore the method and effect of Peng's electrocoagulation under nasal endoscope in the treatment of intractable epistaxis.Methods A retrospective analysis was performed on 120 patients with intractable epistaxis confirmed by nasal endoscopy, and admitted to the hospital from December 2013 to December 2017. All the 120 patients underwent electrocoagulation and hemostasis with peng's electric knife under nasal endoscopic surveillance, combined with local microtamponade with gelatin sponge. The therapeutic effect was observed by postoperative follow up of 3 months.Results 80 cases were cured after once treatment, 16 cases were cured after twice treatment, and 6 cases were cured after nasal septum plasty due to severe deviation of nasal septum. All patients had not complications such as cardio-cerebrovascular accident, perforation of nasal septum and nasal adhesion.Conclusion Nasal endoscopy examination can accurately locate the bleeding site of refractory epistaxis. Peng's electrocoagulation assisted by nasal endoscopy is effective and safe in the treatment of epistaxis. It has a high cure rate, fewer complications and less pain, especially suitable for elderly patients with systemic diseases. It is worthy of clinical promotion.
引文
[1] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组,中华医学会耳鼻咽喉头颈外科学分会鼻科学组.鼻出血诊断及治疗指南(草案)[J].中华耳鼻咽喉头颈外科杂,2015,50(4):265-267.Department of Rhinology,Editorial Committee of Chinese Journal of Otorhinolaryngology Head and Neck Surgery.,Department of Rhinology,the Chinese Society of Otorhinolaryngology Head and Neck Surgery,Chinese Medical Association.Guidelines for the diagnosis and treatment of epistaxis (draft) [J].Chinese Journal of Otolaryngology Head and Neck Surgery,2015,50(4):265-267.
[2] Elahi MM,Parnes LS,Fox AJ,et al.Therapeutic embolization in the of intractable epistaxis[J].Arch Otolaryngol Head Neck Surg,1995,121(1):65-69.
[3] 张满峰,于娜.顽固性鼻出血68例临床分析[J].临床耳鼻咽喉科杂志,2004,18(9):569-570.Zhang MF,Yu N.Clinical analysis of 68 cases with intractable epistaxis[J],Journal of Clinical Otorhinolaryngology,2004,18( 9):569-570.
[4] 张兆焕,乐加汉.彭氏多功能外科解剖器切除扁桃体的对比研究[J].中国医师进修杂志,2008,31(6):15-16.Zhang ZH,Le JH.The value of Peng's multe operation dissector in tonsillectomy [J].Chinese Journal of Postgraduates of Medicine,2008,31(6):15-16.
[5] 王艳,张庆泉.彭氏电刀在鼻内镜下腺样体手术中止血的应用[J].临床医学工程,2011,18 (10):1505-1506.Wang Y,Zhang QQ.Applications of PMOD in the Hemostasis of Nasal Endoscopic Adenoidectomy [J].Clinical Medical Engineering,2011,18 (10):1505-1506.
[6] 唐建勇,郭万宏,何端军.鼻内镜下鼻腔深部出血的定位与治疗[J].中国耳鼻咽喉颅底外科杂志,2017,23(5):485-486.Tang JY,Guo WH,He DJ.Location and treatment of deep nasal bleeding under nasal endoscopy[J].Chin J Otorhinolaryngol Skull Base Surg,2017,23(5):485-486.
[7] 李长清,黄忠会,张友骥,等.隐蔽难治性鼻出血诊疗策略[J],中国耳鼻咽喉头颈外科,2008,15(10):589-590.Li CQ,Huang ZH,Zhang YJ,et al.Diagnosis and treatment strategy of concealed intractable epistaxis[J].Chinese Archives of Otolaryngology-Head and Neck Surgery,2008,15(10):589-590.
[8] 钱卓明,刘锦峰,王宁宇.下鼻道后穹窿部鼻出血特点及内镜治疗分析[J].中国耳鼻咽喉颅底外科杂志,2018,24(3):273-276.Qian ZM,Liu JF,Wang NY,et al.The characteristics and endoscopic treatment in patients with epistaxis in the posterior fornix of the inferior nasal canal.[J].Chin J Otorhinolaryngol Skull Base Surg,2018,24(3):273-276.
[2] Elahi MM,Parnes LS,Fox AJ,et al.Therapeutic embolization in the of intractable epistaxis[J].Arch Otolaryngol Head Neck Surg,1995,121(1):65-69.
[3] 张满峰,于娜.顽固性鼻出血68例临床分析[J].临床耳鼻咽喉科杂志,2004,18(9):569-570.Zhang MF,Yu N.Clinical analysis of 68 cases with intractable epistaxis[J],Journal of Clinical Otorhinolaryngology,2004,18( 9):569-570.
[4] 张兆焕,乐加汉.彭氏多功能外科解剖器切除扁桃体的对比研究[J].中国医师进修杂志,2008,31(6):15-16.Zhang ZH,Le JH.The value of Peng's multe operation dissector in tonsillectomy [J].Chinese Journal of Postgraduates of Medicine,2008,31(6):15-16.
[5] 王艳,张庆泉.彭氏电刀在鼻内镜下腺样体手术中止血的应用[J].临床医学工程,2011,18 (10):1505-1506.Wang Y,Zhang QQ.Applications of PMOD in the Hemostasis of Nasal Endoscopic Adenoidectomy [J].Clinical Medical Engineering,2011,18 (10):1505-1506.
[6] 唐建勇,郭万宏,何端军.鼻内镜下鼻腔深部出血的定位与治疗[J].中国耳鼻咽喉颅底外科杂志,2017,23(5):485-486.Tang JY,Guo WH,He DJ.Location and treatment of deep nasal bleeding under nasal endoscopy[J].Chin J Otorhinolaryngol Skull Base Surg,2017,23(5):485-486.
[7] 李长清,黄忠会,张友骥,等.隐蔽难治性鼻出血诊疗策略[J],中国耳鼻咽喉头颈外科,2008,15(10):589-590.Li CQ,Huang ZH,Zhang YJ,et al.Diagnosis and treatment strategy of concealed intractable epistaxis[J].Chinese Archives of Otolaryngology-Head and Neck Surgery,2008,15(10):589-590.
[8] 钱卓明,刘锦峰,王宁宇.下鼻道后穹窿部鼻出血特点及内镜治疗分析[J].中国耳鼻咽喉颅底外科杂志,2018,24(3):273-276.Qian ZM,Liu JF,Wang NY,et al.The characteristics and endoscopic treatment in patients with epistaxis in the posterior fornix of the inferior nasal canal.[J].Chin J Otorhinolaryngol Skull Base Surg,2018,24(3):273-276.