Metternich F U, Brusis T
Klinik für HNO-Heilkunde, Kopf- und Halschirurgie, Kliniken der Stadt Köln, Krankenhaus Holweide, Akadem. Lehrkrankenhaus, dr Universität zu Köln.
Laryngorhinootologie. 1998 Oct;77(10):582-6. doi: 10.1055/s-2007-997030.
Epistaxis is one of the most common otolaryngological emergencies. In cases of bleeding from the anterior or the lower posterior part of the nose, epistaxis could usually be treated with cauterization and anterior or posterior nasal packing. More invasive methods of treatment are the endonasal coagulation of the sphenopalatine artery and the transantral ligation of the maxillary artery. Bleeding from the upper posterior part of the nose usually originates from the anterior and the posterior ethmoidal artery. In most cases a specific styptic treatment in the upper posterior part of the nose is not possible because of a diffuse bleeding from the ethmoidal arteries into the ethmoidal sinus and the lateral wall of the nasal cavity. In this study the endoscopic ethmoidectomy is presented as the therapy of epistaxis from the ethmoidal arteries.
In the retrospective study the charts of twenty patients with intractable epistaxis from the upper posterior part of the nasal cavity were reviewed. In all cases the bleeding could not be controlled with anterior and posterior nasal packing. In seventeen patients the bleeding could be controlled with a unilateral or bilateral endoscopic ethmoidectomy (average follow-up: 36.5 months). Three patients who complained of a coagulopathy and an arterial hypertonia developed diffuse recurrent bleeding from multiple sources. In one case the recurrent bleeding was controlled by an unilateral transantral ligation of the maxillary artery and a bilateral revision of the ethmoidectomy. In two patients the recurrent bleeding was treated with bilateral posterior nasal packing.
The endoscopic ethmoidectomy is an efficient therapy of intractable epistaxis from the ethmoidal arteries if systemic coagulopathy and arterial hypertonia are excluded. The ethmoidectomy can be performed by any head and neck surgeon who is familiar with endonasal surgery.
鼻出血是最常见的耳鼻喉科急症之一。对于鼻腔前部或后下部出血的情况，鼻出血通常可通过烧灼术以及鼻腔前后填塞进行治疗。更具侵入性的治疗方法是蝶腭动脉鼻内凝固术和上颌动脉经窦结扎术。鼻腔后上部出血通常源自筛前动脉和筛后动脉。在大多数情况下，由于筛动脉向筛窦和鼻腔外侧壁弥漫性出血，无法对鼻腔后上部进行特定的止血治疗。在本研究中，内镜下筛窦切除术被作为治疗筛动脉引起的鼻出血的方法提出。
在这项回顾性研究中，对20例鼻腔后上部顽固性鼻出血患者的病历进行了回顾。在所有病例中，鼻腔前后填塞均无法控制出血。17例患者的出血通过单侧或双侧内镜下筛窦切除术得到控制（平均随访时间：36.5个月）。3例患有凝血病和动脉高血压的患者出现了多部位弥漫性复发性出血。1例患者的复发性出血通过单侧上颌动脉经窦结扎术和双侧筛窦切除术修正得以控制。2例患者的复发性出血采用双侧鼻腔后填塞进行治疗。
如果排除全身性凝血病和动脉高血压，内镜下筛窦切除术是治疗筛动脉引起的顽固性鼻出血的有效方法。任何熟悉鼻内手术的头颈外科医生均可进行筛窦切除术。
