Kosugi Eduardo Macoto, Balsalobre Leonardo, Mangussi-Gomes João, Tepedino Miguel Soares, San-da-Silva Daniel Marcus, Cabernite Erika Mucciolo, Hermann Diego, Stamm Aldo Cassol
Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Setor de Rinologia, São Paulo, SP, Brazil.
Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Setor de Rinologia, São Paulo, SP, Brazil; Complexo Hospitalar Edmundo Vasconcelos, Centro de Otorrinolaringologia e Fonoaudiologia, São Paulo, SP, Brazil.
Braz J Otorhinolaryngol. 2018 May-Jun;84(3):290-297. doi: 10.1016/j.bjorl.2017.12.007. Epub 2018 Jan 20.
Since the introduction of nasal endoscopy into the field of Otorhinolaryngology, the treatment paradigm for cases of severe epistaxis has shifted toward early and precise identification of the bleeding site. Although severe epistaxis is usually considered to arise from posterior bleeding, an arterial vascular pedicle in the superior portion of the nasal septum, around the axilla projection of the middle turbinate, posterior to the septal body, frequently has been observed. That vascular pedicle was named the Stamm's S-point.
The aim of this study was to describe the S-point and report cases of severe epistaxis originating from it.
A retrospective case series study was conducted. Nine patients with spontaneous severe epistaxis, where the S-point was identified as the source of bleeding, were treated between March 2016 and March 2017.
Male predominance (77.8%) with age average of 59.3 years old were reported. Most cases presented comorbidities (88.9%) and were not taking acetylsalicylic acid (66.7%). A predominance of left sided involvement (55.6%) and anteroposterior bleeding being the principal initial presentation (77.8%) was seen. Six patients (66.7%) presented with hemoglobin levels below 10g/dL, and four (44.4%) required blood transfusion. Cauterization of S-point was performed in all patients, with complete resolution of bleeding. No patient experienced recurrence of severe epistaxis.
The Stamm's S-point, a novel source of spontaneous severe epistaxis, is reported, and its cauterization was effective and safe. Otolaryngologists must actively seek this site of bleeding in cases of severe epistaxis.
自从鼻内镜检查引入耳鼻咽喉科领域以来，严重鼻出血病例的治疗模式已转向早期精确识别出血部位。尽管严重鼻出血通常被认为是由后部出血引起的，但在鼻中隔上部、中鼻甲腋突周围、鼻中隔体后方的动脉血管蒂却经常被观察到。该血管蒂被命名为施塔姆S点。
本研究旨在描述S点并报告源自该点的严重鼻出血病例。
进行了一项回顾性病例系列研究。2016年3月至2017年3月期间，对9例自发性严重鼻出血患者进行了治疗，这些患者的出血源被确定为S点。
报告显示男性占主导（77.8%），平均年龄为59.3岁。大多数病例伴有合并症（88.9%），且未服用乙酰水杨酸（66.7%）。左侧受累占主导（55.6%），主要初始表现为前后部出血（77.8%）。6例患者（66.7%）血红蛋白水平低于10g/dL，4例（44.4%）需要输血。所有患者均对S点进行了烧灼，出血完全停止。没有患者出现严重鼻出血复发。
报告了施塔姆S点，这是一种新的自发性严重鼻出血来源，对其烧灼有效且安全。耳鼻咽喉科医生在严重鼻出血病例中必须积极寻找该出血部位。
