Department of Otorhinolaryngology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.
Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.
Eur Arch Otorhinolaryngol. 2020 Jul;277(7):1969-1975. doi: 10.1007/s00405-020-05914-y. Epub 2020 Mar 13.
Epistaxis that is refractory to conservative management can be treated with endoscopic sphenopalatine artery ligation (ESPAL). Although rare, ethmoidal artery (EA) bleeding can be a cause of rebleeding after successful ESPAL. EA bleeding is diagnosed by angiography and can also be identified during surgical exploration. However, since the angiographic embolization of the EA is contraindicated, surgical hemostasis is mandatory. This study investigated whether paranasal sinus (PNS) CT could provide information for predicting EA bleeding without angiography in patients with refractory epistaxis requiring ESPAL.
Forty-seven patients, who were surgically treated [with ESPAL or EA ligation (EAL)] for refractory epistaxis from March 2010 to June 2019, were retrospectively analyzed. A positive PNS CT finding for EA bleeding was defined as the presence of soft tissue densities having continuity with the EA pathway, accompanied by a partially deficient surrounding bony canal. These findings as well as soft tissue densities in each paranasal sinus were compared between the ESPAL and EAL groups.
All patients in the EAL group had positive CT findings of EA bleeding, compared to only 12.2% in the ESPAL group (P < 0.001). The rate of soft tissue densities within the frontal and sphenoid sinuses were noted in 26.8% and 17.1% of patients in the ESPAL group, compared to 83.3% and 83.3% of patients in the EAL group (P = 0.013 and P = 0.003, respectively).
PNS CT might be useful for predicting EA bleeding in patients with refractory epistaxis requiring surgical hemostasis.
经保守治疗无效的鼻出血可采用内镜蝶腭动脉结扎术（ESPAL）治疗。虽然很少见，但筛前动脉（EA）出血可能是 ESPAL 成功后再次出血的原因。EA 出血通过血管造影诊断，也可在手术探查时识别。然而，由于 EA 的血管内栓塞是禁忌的，因此必须进行手术止血。本研究探讨了在需要 ESPAL 的难治性鼻出血患者中，鼻窦 CT 是否可以在无需血管造影的情况下提供有关预测 EA 出血的信息。
回顾性分析了 2010 年 3 月至 2019 年 6 月期间因难治性鼻出血接受手术治疗（ESPAL 或 EA 结扎术（EAL））的 47 例患者。EA 出血的鼻窦 CT 阳性发现定义为与 EA 路径连续性存在的软组织密度，伴有部分周围骨管缺失。比较了 ESPAL 组和 EAL 组的这些发现以及每个鼻窦的软组织密度。
EAL 组所有患者均有 EA 出血的 CT 阳性发现，而 ESPAL 组仅为 12.2%（P<0.001）。ESPAL 组中，额窦和蝶窦内软组织密度的发生率分别为 26.8%和 17.1%，而 EAL 组分别为 83.3%和 83.3%（P=0.013 和 P=0.003）。
鼻窦 CT 可能有助于预测需要手术止血的难治性鼻出血患者的 EA 出血。
