山东大学耳鼻喉眼学报 ›› 2016, Vol. 30 ›› Issue (5): 88-91.doi: 10.6040/j.issn.1673-3770.0.2016.028

• 论著 • 上一篇    下一篇

外伤性颌内动脉损伤引起严重鼻出血的诊断及治疗探讨(附12例报告)

李育广,刘凤英,刘茜   

  1. 解放军第184医院耳鼻咽喉头颈外科, 江西 鹰潭 335000
  • 收稿日期:2016-01-23 出版日期:2016-10-20 发布日期:2016-10-20
  • 作者简介:李育广. E-mail:lyg184yyy @aliyun.com

Severe nasal bleeding caused by traumatic injury of the internal carotid artery: with a report of 12 cases.

LI Yuguang, LIU Fengying, LIU Qian   

  1. Department of Otorhinolaryngology, the No.184 Hospital of Chinese PLA, Yingtan 335000, Jiangxi, China
  • Received:2016-01-23 Online:2016-10-20 Published:2016-10-20

摘要: 目的 探讨颌面部外伤引起的颌内动脉损伤致严重鼻出血的发病机制、出血特点、诊断及治疗方法。 方法 回顾分析经手术或数字减影血管造影(DSA)证实颌面外伤引起的颌内动脉损伤致严重鼻出血12例的病例资料。 结果 6例行鼻内镜检查,见鼻腔外侧壁黏膜下有搏动出血,迅速改行柯-陆氏入路找到出血责任血管并止血,其中4例同期行上颌骨、颧骨骨折复位、钛板坚强内固定术。6例行DSA确诊并行血管栓塞治疗。 结论 对颌面外伤后反复鼻腔大出血患者,应考虑颌内动脉损伤,应尽早行鼻内镜检查止血和/或DSA检查并行栓塞治疗。若行鼻内镜检查止血过程中来不及栓塞治疗,可立即经柯-陆氏入路找到出血责任血管行血管结扎或电凝,也可填塞碘仿纱条止血。止血后请口腔颌面外科同期行颌面骨折复位坚强内固定术。

关键词: 鼻出血, 数字减影血管造影, 栓塞, 颌内动脉

Abstract: Objective To explore the the pathogenesis, characteristics, diagnosis and treatment of severe nasal bleeding caused by traumatic injury of the internal carotid artery. Method The clinical data of 12 cases were retrospectively analyzed. Result Of the 12 cases, 6 cases underwent nasal endoscopy and were found beating bleeding at the submucosal lateral nasal wall, then were treated by the Caldwell Luc approach to stop bleeding, meanwhile 4 cases of them were treated by maxillary fracture and zygomatic fracture reduction and titanium plate internal fixation. Another 6 cases were made definite diagnosis with digital subtraction angiography(DSA)and were treated by parallel vascular embolization. Conclusion As for patients with maxillofacial injury with repeated nasal hemorrhage, they should be considered and treated by nasal endoscopy and/or DSA examination and embolization. If embolization is too late in the process of nasal endoscopy bleeding, ligation or electric coagulation could be performed out by the Caldwell Luc approach, also iodoform gauze could be used for stuffing. After stopped bleeding, maxillofacial fracture reduction and internal fixation should be done.

Key words: Epitaxis, Embolization, Internal carotid artery, Digital subtraction angiography

中图分类号: 

  • R765.23
[1] 谭建国. 上颌窦闭合性骨折致严重鼻出血11例[J].中华创伤杂志, 2002,18(9):564-565.
[2] 张震康,邱蔚六,皮昕. 口腔颌面外科临床解剖学[M]. 济南:山东科学技术出版社,2001:248-249.
[3] 马金阳,良博娟,汪雷,等.颅脑创伤后反复严重鼻出血13例诊疗分析[J].中华神经外科杂志,2014,30(3):252-255. MA Jinyang, LIANG Bojuan, WANG Lei, et al. Clinical analysis on recurred and serious epistax after craniocerebral trauma(report of 13 cases)[J]. Chin J Neurosurgery, 2014, 30(3):252-255.
[4] Nobuhiko A, Suqanuma E, Babaev V R, et al. The diagnoses of traumatic aneurysm in internal carotid artery[J]. Surg Neurol, 1992, 37(1):59-61.
[5] 刘一支,倪才方,朱晓黎,等. 选择性颈动脉分支栓塞术在鼻口腔大出血中的应用[J].实用放射学杂志,2000,16(3):151-153.
[6] 沈国鑫,吴根华,唐杰,等.外伤性颌内动脉鼻出血的导管栓塞治疗[J].中华创伤杂志,2005, 21(3): 220-221.
[7] 韩德民, 张罗. 内镜鼻窦外科学[M]. 2版. 北京:人民卫生出版社,2010:143.
[1] 刘迪,谢应恒,朱斌,马霖,关兵,王莹,曹清,焦成,严齐,孙海勇,马伟. 不同性别未成年人鼻出血与环境气象因素相关性及滞后效应[J]. 山东大学耳鼻喉眼学报, 2026, 40(3): 47-54.
[2] 朝博,苏优勒,郭若宇,付嘉越,吕宪利. 侧颅底硬脑膜动静脉瘘的特点及治疗[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 1-7.
[3] 彭鑫,魏先锋,梁毅博,乔杰,王巍,林鹏,李丽. 扁桃体癌合并多发急性脑梗死的特鲁索综合征1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 116-120.
[4] 郑露,程杰,欧阳虹,池花明,杜敬东. A型血友病致难治性鼻出血1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2024, 38(5): 86-90.
[5] 王丽,袁虎威,潘宏光. 儿童鼻腔牙4例并文献复习[J]. 山东大学耳鼻喉眼学报, 2021, 35(1): 16-20.
[6] 任昱, 肖旭平. 颈动脉损伤诊断与治疗进展[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 105-109.
[7] 李强,刘志元,周涵. 鼻内镜下蝶腭动脉阻断术治疗老年难治性鼻出血[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 92-95.
[8] 赵青,周涵,殷敏,冯剑,张佳程,刘雅琴,沈宇杰,林子萍,董伟达. 鼻咽纤维血管瘤术前超选择性血管栓塞的应用价值[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 100-105.
[9] 李萍. 鼻内镜下单极电凝治疗成人难治性鼻出血102例[J]. 山东大学耳鼻喉眼学报, 2015, 29(4): 88-89.
[10] 王英俊,孙彦,李薇,华辉,黄沂传,葛瑞锋,韩敏. 喉癌、喉咽癌手术相关肺血栓栓塞症的临床特点[J]. 山东大学耳鼻喉眼学报, 2014, 28(2): 51-54.
[11] 张旻,尹兆富,白永. 鼻内镜下治疗妊娠期严重鼻出血2例体会[J]. 山东大学耳鼻喉眼学报, 2014, 28(1): 87-88.
[12] 肖路,练状,魏毅玲 . 鼻内镜鼻腔扩容手术在难治性鼻出血治疗中的应用[J]. 山东大学耳鼻喉眼学报, 2013, 27(6): 59-60.
[13] 吴彦桥,邸斌,李军,高晓红 . 鼻内镜下难治性鼻出血出血点寻找及止血策略[J]. 山东大学耳鼻喉眼学报, 2013, 27(4): 1-3.
[14] 余鹏举1,许风雷2,江满杰2. 鼻内镜治疗难治性鼻出血121例疗效分析[J]. 山东大学耳鼻喉眼学报, 2013, 27(4): 4-5.
[15] 侯艳鹏1,唱得龙2,邰旭辉1,徐振明1,杨昕1,朱宝玉1. 鼻内镜下电凝切割器电凝蝶腭动脉治疗鼻出血[J]. 山东大学耳鼻喉眼学报, 2013, 27(4): 6-7.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!