Strong E B, Bell D A, Johnson L P, Jacobs J M
Department of Otolaryngology, University of Utah, Salt Lake City, USA.
Otolaryngol Head Neck Surg. 1995 Dec;113(6):674-8. doi: 10.1016/S0194-59989570004-8.
After posterior nasal packing, the two most common therapies for intractable epistaxis are transantral ligation of the internal maxillary artery and percutaneous embolization of the distal internal maxillary artery. However, optimal management of intractable posterior epistaxis remains controversial. We retrospectively reviewed the charts of 21 patients treated for intractable epistaxis and obtained data on presentation, risk factors, treatment, success rates, complications, and cost. Twelve patients received percutaneous embolization, five underwent transantral ligation, and four required both. The success rates for transantral ligation and percutaneous embolization were 89% and 94%, respectively. No mortality or serious morbidity occurred with either technique. A cost comparison revealed that transantral ligation was moderately less expensive than percutaneous embolization ($5941 vs. $6783). Although some authors advocate transantral ligation or percutaneous embolization as the procedure of choice for intractable epistaxis, a direct comparison of efficacy and cost reveals that they are comparable procedures with specific strengths and weaknesses. We present our experience and a review of the literature, highlighting the indications and advantages of each technique. We conclude that the choice of treatment modality should be based on the benefits of each procedure as it pertains to the specific needs of the individual patient.
后鼻孔填塞后，治疗难治性鼻出血最常用的两种方法是经上颌窦结扎上颌内动脉和经皮栓塞上颌内动脉远端。然而，难治性后鼻孔出血的最佳治疗方法仍存在争议。我们回顾性分析了21例难治性鼻出血患者的病历，获取了关于临床表现、危险因素、治疗方法、成功率、并发症及费用的数据。12例患者接受了经皮栓塞治疗，5例行经上颌窦结扎术，4例两种方法均需采用。经上颌窦结扎术和经皮栓塞术的成功率分别为89%和94%。两种技术均未导致死亡或严重并发症。成本比较显示，经上颌窦结扎术的费用略低于经皮栓塞术（5941美元对6783美元）。尽管一些作者主张将经上颌窦结扎术或经皮栓塞术作为难治性鼻出血的首选治疗方法，但对疗效和成本的直接比较表明，它们是具有特定优缺点的可比方法。我们介绍了我们的经验并对文献进行了综述，强调了每种技术的适应证和优势。我们得出结论，治疗方式的选择应基于每种方法针对个体患者特定需求所带来的益处。
