Franke Mareike, Franke Jasper, Saager Christian, Barthel Sven, Riemann Randolf, Mueckner Kersten
Diagnostic and Interventional Radiology, Dr. Hancken Clinic, 21680 Stade, Germany.
Department of Radiology, Wesling Hospital Minden, University Hospital of the Ruhr University Bochum, 32429 Minden, Germany.
Radiol Res Pract. 2020 Aug 20;2020:5710313. doi: 10.1155/2020/5710313. eCollection 2020.
Today, there are still no uniform guidelines for the treatment of epistaxis. Furthermore, it is widely debated whether embolization or surgical approaches should be the first choice of treatment for intractable posterior epistaxis after conservative measures have failed. In several meta-analyses, it is reported that endoscopic sphenopalatine artery ligation and embolization have similar success rates, but embolization was associated with more severe neurological complications. Regarding existing literature, there are many comparative analyses of surgical methods but none for embolization protocols. Against this backdrop of a lack of uniform standards in embolization techniques, we present a retrospective evaluation of what has emerged to be best procedural practice for endovascular treatment of epistaxis in our department using microsphere particles and microcoils, in particular regarding precaution measures to avoid neurological complications. In our retrospective data analysis of 141 procedures in 123 patients, performed between 2008 and 2019, we find success rates very similar to those reported in other studies (95.1% immediate-stop-of-bleeding success and 90.2% overall embolization success) but did not encounter any major neurological complication opposed to other reports. We suggest some aspects of our protocol as precaution measure to avoid neurological complications. More generally and perhaps even more importantly, we make a strong case for standardization for embolization techniques to the level of details in surgical procedure standardization to enable an apples to apples comparison of embolization techniques to each other and of intervention vs. surgery.
如今，鼻出血的治疗仍没有统一的指南。此外，对于在保守治疗失败后，栓塞术或手术方法是否应作为难治性后鼻孔鼻出血的首选治疗方法，存在广泛的争论。在几项荟萃分析中，据报道内镜下蝶腭动脉结扎术和栓塞术的成功率相似，但栓塞术与更严重的神经并发症相关。关于现有文献，有许多关于手术方法的比较分析，但没有关于栓塞方案的分析。在栓塞技术缺乏统一标准的背景下，我们对本部门使用微球颗粒和微线圈进行鼻出血血管内治疗的最佳程序实践进行了回顾性评估，特别是关于避免神经并发症的预防措施。在我们对2008年至2019年间123例患者的141例手术的回顾性数据分析中，我们发现成功率与其他研究报告的非常相似（即时止血成功率为95.1%，总体栓塞成功率为90.2%），但与其他报告不同的是，我们没有遇到任何重大神经并发症。我们建议将我们方案的一些方面作为避免神经并发症的预防措施。更普遍甚至更重要的是，我们强烈主张将栓塞技术标准化到手术程序标准化的细节水平，以便能够对栓塞技术之间以及干预与手术之间进行公平比较。
