Liu Xiaohai, Wang Pengfei, Li Mingchu, Chen Ge
Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China.
Department of Neurosurgery, Hebei General Hospital, Shijiazhuang, China.
Front Surg. 2023 Jul 26;10:1203409. doi: 10.3389/fsurg.2023.1203409. eCollection 2023.
Postoperative epistaxis is a very rare but severe complication after endoscopic endonasal transsphenoidal surgery (EETS) that can lead to catastrophic consequences. However, the incidence, risk factors, management and prevention of postoperative epistaxis remain unclear.
Consecutive patients with pituitary adenoma (PA), Rathke's cleft cyst, craniopharyngioma, or clival chordoma who received EETS in our department between September 2020 and November 2022 were retrospectively analyzed. The incidence, risk factors, management and prevention of postoperative epistaxis were investigated and analyzed.
A total of 557 consecutive patients who received EETS were included in this study. Eight patients (1.4%) (7 PAs and 1 Rathke's cleft cyst) experienced severe postoperative epistaxis. The size of the PAs was 9.6 mm-46.2 mm, with a median size of 22.1 mm. Epistaxis occurred 4 h to 30 days (median 14.5 days) postoperatively. Bleeding was stopped in 3 patients after nasal packing with iodoform gauze. The remaining 5 patients for whom nasal packing was insufficient were all sent to the operating room, and posterior nasal septal artery (PNSA) bleeding was identified and successfully treated with endoscopic bleeding artery electrocauterization under general anesthesia. In the EETS, all 8 patients had downward extension of the septal mucosal incision, in which 6 had intraoperative bleeding of PNSA that were cauterized by bipolar diathermy. Four patients had causative factors, including administration of antiplatelet agents, Valsalva-like manoeuvre, nose blowing and removal of nasal packing, respectively. No patients had recurrent epistaxis during the follow-up period.
Post-EETS epistaxis is a rare but severe complication that could lead to catastrophic consequences, and one of the most common bleeding sources is the PNSA. Endoscopic bleeding artery electrocauterization under general anesthesia may be a safe, economic and effective measure for epistaxis refractory to nasal packing. Avoiding excessive downward extension of the septal mucosal incision could contribute to the prevention of postoperative epistaxis.
术后鼻出血是鼻内镜下经鼻蝶窦手术（EETS）后一种非常罕见但严重的并发症，可导致灾难性后果。然而，术后鼻出血的发生率、危险因素、处理及预防仍不明确。
回顾性分析2020年9月至2022年11月在我科接受EETS的垂体腺瘤（PA）、拉克氏囊肿、颅咽管瘤或斜坡脊索瘤患者。对术后鼻出血的发生率、危险因素、处理及预防进行调查分析。
本研究共纳入557例连续接受EETS的患者。8例患者（1.4%）（7例PA和1例拉克氏囊肿）发生严重术后鼻出血。PA的大小为9.6 mm - 46.2 mm，中位大小为22.1 mm。鼻出血发生在术后4小时至30天（中位14.5天）。3例患者经碘仿纱条鼻腔填塞后出血停止。其余5例鼻腔填塞无效的患者均被送进手术室，确认是鼻中隔后动脉（PNSA）出血，并在全身麻醉下通过内镜下出血动脉电灼成功治疗。在EETS中，所有8例患者的鼻中隔黏膜切口均向下延伸，其中6例术中PNSA出血，采用双极电凝烧灼。4例患者有诱发因素，分别包括服用抗血小板药物、类似瓦尔萨尔瓦动作、擤鼻和取出鼻腔填塞物。随访期间无患者复发出血。
EETS术后鼻出血是一种罕见但严重的并发症，可导致灾难性后果，最常见的出血来源之一是PNSA。全身麻醉下内镜下出血动脉电灼可能是鼻腔填塞难治性鼻出血的一种安全、经济有效的措施。避免鼻中隔黏膜切口过度向下延伸有助于预防术后鼻出血。
