Anschuetz Lukas, Bonali Marco, Guarino Pierre, Fabbri Filippo B, Alicandri-Ciufelli Matteo, Villari Domenico, Caversaccio Marco, Presutti Livio
1 Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy.
2 Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
Otolaryngol Head Neck Surg. 2017 Oct;157(4):700-706. doi: 10.1177/0194599817726982. Epub 2017 Sep 5.
Objective Transcanal exclusive endoscopic ear surgery requires the management of the endoscope and the surgical instruments in the external auditory canal. Bleeding in this narrow space is one of the most challenging issues, especially for novice endoscopic ear surgeons. We aim to assess the severity and occurrence of bleeding and describe strategies to control the bleeding during endoscopic ear surgery. We hypothesize that bleeding is reasonably controllable in endoscopic ear surgery. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods We retrospectively assessed 104 consecutive cases of exclusive endoscopic ear surgery at the University Hospital of Modena, Italy. The surgical videos and the patient charts were carefully investigated and analyzed. Results Hemostatic agents included injection of diluted epinephrine (1:200,000, 2% mepivacaine), cottonoids soaked with epinephrine (1:1000), mono- or bipolar cautery, washing with hydrogen peroxide, and self-suctioning instruments. The localization of bleeding in the external auditory canal was most frequently the posterior superior part, and inside of the middle ear, it was the pathology itself. Statistical analysis revealed significant differences comparing the mean arterial pressure and the type of intervention among bleeding scores. Conclusion The management of bleeding in endoscopic ear surgery is feasible through widely available hemostatic agents in reasonable frequency. This study gives an instructive overview on how to manage the bleeding in the exclusive endoscopic technique. Even the highest bleeding scores could be managed in an exclusively endoscopic technique.
目的 经耳道内镜耳科手术需要在外耳道内操作内镜和手术器械。在这个狭窄空间内出血是最具挑战性的问题之一，尤其是对于内镜耳科新手医生。我们旨在评估出血的严重程度和发生率，并描述内镜耳科手术中控制出血的策略。我们假设内镜耳科手术中的出血是可以合理控制的。研究设计 病例系列并进行图表回顾。研究地点 三级转诊中心。研究对象和方法 我们回顾性评估了意大利摩德纳大学医院连续104例经耳道内镜耳科手术病例。仔细研究和分析了手术视频和患者病历。结果 止血剂包括注射稀释肾上腺素（1:200,000，2%甲哌卡因）、用肾上腺素（1:1000）浸泡的棉片、单极或双极电灼、用过氧化氢冲洗以及自吸式器械。外耳道内出血最常见于后上部分，而中耳内出血则最常见于病变本身。统计分析显示，在出血评分中，比较平均动脉压和干预类型存在显著差异。结论 通过合理使用广泛可得的止血剂，内镜耳科手术中的出血管理是可行的。本研究对内耳镜技术中如何处理出血给出了指导性概述。即使是最高的出血评分，也可以通过单纯的内镜技术进行处理。
