内镜经鼻颅底手术后鼻出血的危险因素。
Risk factors of epistaxis after endoscopic endonasal skull base surgeries.
机构信息
Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China; Neurosurgical Institute of Fudan University, Shanghai 200040, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200040, China; Shanghai Pituitary Tumor Center, Shanghai 200040, China; National Center for Neurological Disorders, China.
Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China; Neurosurgical Institute of Fudan University, Shanghai 200040, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200040, China; Shanghai Pituitary Tumor Center, Shanghai 200040, China; National Center for Neurological Disorders, China.
出版信息
Clin Neurol Neurosurg. 2022 Jun;217:107243. doi: 10.1016/j.clineuro.2022.107243. Epub 2022 Apr 7.
BACKGROUND
Epistaxis after endoscopic endonasal skull base surgeries does not typically occur as an accidental circumstance but often results from multiple factors. We aimed to assess the possible risk factors associated with postoperative epistaxis.
METHODS
Patients who underwent endoscopic endonasal skull base surgery at Huashan hospital from August 2018 to November 2019 were enrolled in the study. Postoperative epistaxis was defined as severe, persistent, or recurrent arterial nosebleed, which required therapeutic intervention. Patients were divided into the epistaxis and no epistaxis groups. The incidence, clinical characteristics, management, and intraoperative findings were recorded.
RESULTS
A total of 762 patients were included in the study. 20 (2.6%) patients experienced postoperative epistaxis, which happened in a delayed fashion between 6 and 30 postoperative days. Multivariate logistic regression analysis showed that arterial hypertension (OR=3.394, 95%CI: 1.094-10.531, P = 0.034) and preoperative systolic blood pressure (SBP) (OR=1.035, 95%CI: 1.002-1.068) were identified as predictors for postoperative epistaxis. The bleeding sites were identified at the left posterior septal artery (PSA) in 10 (62.5%) cases, the right PSA in 4 (25%) cases, the left palatovaginal artery in 1 (6.25%) case, and the right inferior turbinate branch of the posterior lateral nasal artery in 1 (6.25%) case, respectively. Direct bipolar cauterization was used to stop the bleeding. After definitive treatment, no patients had recurrent epistaxis.
CONCLUSIONS
Arterial hypertension and preoperative SBP were associated with postoperative epistaxis after endoscopic endonasal skull base surgery, and the left PSA contributed to the dominant site of bleeding during surgical re-exploration.
背景
内镜经鼻颅底手术后的鼻出血通常不是偶然发生的，而是由多种因素引起的。我们旨在评估与术后鼻出血相关的可能危险因素。
方法
本研究纳入 2018 年 8 月至 2019 年 11 月在华山医院接受内镜经鼻颅底手术的患者。术后鼻出血定义为严重、持续或反复的动脉性鼻出血，需要治疗干预。患者分为鼻出血组和无鼻出血组。记录术后鼻出血的发生率、临床特征、处理方法和术中发现。
结果
本研究共纳入 762 例患者。20 例（2.6%）患者发生术后迟发性鼻出血，发生于术后 6-30 天。多因素 logistic 回归分析显示，动脉高血压（OR=3.394，95%CI：1.094-10.531，P=0.034）和术前收缩压（SBP）（OR=1.035，95%CI：1.002-1.068）是术后鼻出血的预测因素。10 例（62.5%）患者的出血部位位于左侧后鼻中隔动脉（PSA），4 例（25%）位于右侧 PSA，1 例（6.25%）位于左侧腭阴道动脉，1 例（6.25%）位于右侧后外侧鼻动脉下鼻甲分支。直接双极电凝用于止血。经过明确的治疗后，无患者再次发生鼻出血。
结论
动脉高血压和术前 SBP 与内镜经鼻颅底手术后的术后鼻出血相关，左侧 PSA 是手术再次探查时出血的主要部位。
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