Sundarajan Karthik, Mani Suresh, Arumugam Karthiga
Upgraded Institute of Otorhinolaryngology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu 600003 India.
Department of Head and Neck Surgery, CMC, Vellore, India.
Indian J Otolaryngol Head Neck Surg. 2023 Dec;75(4):2792-2797. doi: 10.1007/s12070-023-03793-3. Epub 2023 May 15.
Transnasal endoscopic sphenopalatine artery occlusion procedures are becoming the standard of care for intractable posterior epistaxis. Improved endoscopic anatomical features of the lateral nasal wall and endoscopic skill with high-resolution cameras result in a higher success rate of endoscopic intervention. To evaluate the safety and effectiveness of endoscopic cauterization of the sphenopalatine artery (ESPAC) in controlling intractable posterior nasal bleeding. This prospective cohort study enrolled patients with refractory posterior epistaxis from August 2016 to December 2019. The trial recruited patients between 18 and 65 years of age with a history of recurrent and refractory posterior epistaxis receiving endoscopic arterial cauterization due to conservative treatment failure. All of the cases involved bipolar cauterization. Recurrent nosebleeds must pause for at least three months for a procedure to be considered successful. In the first 30 days following surgery, complications are recorded. 415 patients with epistaxis received both inpatient and outpatient care. Transnasal ESPAC was necessary for 36 patients (11.5%). The most common comorbidity was hypertension accounting for 9 (23%) cases. Thus, 26 of 36 (72%) cases had a unilateral ESPAC, while 10 (28%) had a bilateral ESPAC. Twenty-two (61%) and ten (28%) patients had single and two branching patterns of the sphenopalatine artery, respectively. Septal correction and middle meatus antrostomy (44%) were the most performed additional procedures. During the three-month follow-up period, 35 patients in this study had epistaxis control; the success rate of ESPAC was 97.2%. There were no significant postoperative complications found. Endoscopic sphenopalatine artery cauterization is successful in controlling 97.2% of posterior epistaxis. It is safe and effective without any significant complications.
经鼻内镜蝶腭动脉封堵术正成为难治性鼻后出血的标准治疗方法。鼻外侧壁内镜解剖特征的改善以及高分辨率摄像头带来的内镜技术提高，使得内镜干预的成功率更高。为评估内镜下蝶腭动脉烧灼术（ESPAC）控制难治性鼻后出血的安全性和有效性。这项前瞻性队列研究纳入了2016年8月至2019年12月患有难治性鼻后出血的患者。该试验招募了年龄在18至65岁之间、有复发性和难治性鼻后出血病史且因保守治疗失败而接受内镜动脉烧灼术的患者。所有病例均采用双极烧灼术。复发性鼻出血必须至少暂停三个月，手术才被视为成功。在术后的前30天记录并发症。415例鼻出血患者接受了住院和门诊治疗。36例患者（11.5%）需要行经鼻ESPAC。最常见的合并症是高血压，占9例（23%）。因此，36例中的26例（72%）进行了单侧ESPAC，而10例（28%）进行了双侧ESPAC。22例（61%）和10例（28%）患者的蝶腭动脉分别为单支和双支分支模式。鼻中隔矫正和中鼻道鼻窦造口术（44%）是最常进行的附加手术。在三个月的随访期内，本研究中的35例患者鼻出血得到控制；ESPAC的成功率为97.2%。未发现明显的术后并发症。内镜下蝶腭动脉烧灼术成功控制了97.2%的鼻后出血。它安全有效，没有任何明显并发症。
