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1 case cured experience of intractable epistaxis


Glue oozing at the only complete hemostasis. 1 patient clinical data, male, 42 years old, repeated the right post-traumatic nasal nasal bleeding in 6 days. 6 days ago and a car accident, caused by nasal, no coma, taken to local hospitals X-ray film prompted nasal fracture, on the bit, the right nasal bleeding due to the vaseline gauze right anterior nasal cavity; the next day, the right recurrent epistaxis , anti-inflammatory bleeding and transfusion treatment fails, the recent increase in the amount of bleeding, eager to come to our hospital,[link widoczny dla zalogowanych], income homes. Inspection: anemia appearance, mental weakness, vital signs were stable, the right nasal cavity had been packing, there are still bleeding, a diagnosis of traumatic epistaxis, given the right to stop bleeding around the nose packing and anti-inflammatory treatment; night Right nasal bleeding occurred on many occasions, patients and family stress, strongly urge the next morning arterial embolization, transcatheter consultation room, that local anesthesia DSA (DSA), selective embolization; operation repeatedly find, the responsibility not found in blood vessels, embolization all branches of the right maxillary artery and try to get the right nasal packing materials, and bleeding occurs, immediately re-filling the right nasal cavity, postoperative right side of the headache, the Ministry of right cheek swelling, fever, etc., to the symptomatic treatment; 3 days after intranasal endoscopic nasal gauze out slowly and found the top of the right middle of pulsatile bleeding nasal septum, which uses bipolar electric coagulation, place a piece of foam expansion; next few days,[link widoczny dla zalogowanych], nasal bleeding has occurred several times, each time blood is about 5O ~ 100 毫升The ability to self only. Determined by the line of the right ethmoid consultation artery ligation. Under local anesthesia, the right anterior ethmoid artery ligation, the use of endoscopic observation of the right nasal cavity, see the erosion in the diaphragm at the top, there is still oozing, that is, outside of the incision to take the nose piece of connective tissue oozing with biological glue in place Check no bleeding after the end of the surgery. A postoperative inflammation, bleeding,[link widoczny dla zalogowanych], and symptomatic treatment, no recurrence of epistaxis after 1 week, general condition improved, and discharged. During hospitalization, lost 6 units of red blood cells, plasma 400 ml. 2 to discuss the cases, the first stage in the treatment process, due to bleeding more fierce, has not been identified bleeding sites in the nasal packing has been in a local hospital several times to the hospital after the line before and after packing the nose, DSA was not found under the responsibility of blood vessels given artery embolization, not only failed to stop the bleeding, but the bleeding increased,[link widoczny dla zalogowanych], probably because of collateral circulation, the blood pressure. After endoscopic examination revealed the bleeding site, after the nasal septum above the region's blood supply from the intracranial branches of the ophthalmic artery and anterior ethmoidal artery ethmoidal artery ethmoidal artery ligation and the final line,[link widoczny dla zalogowanych], connective tissue and bio-plastic film Paste in the bleeding at the only complete hemostasis. The patients, treatment failure is not identified on the site of bleeding, DSA was not found responsible blood vessel, blind to the arterial embolization. Arterial bleeding caused by the screen is a contraindication to embolization. In 1974, Sokoloff and so the first application for treatment of vascular thrombosis is difficult to control the nasal bleeding, successful. In recent years, embolization is increasingly used in patients with nasal bleeding. Hemostatic embolization embolization is the key to success l_2 before vascular angiography, the bleeding time to find the bleeding vessel. External carotid artery and internal carotid artery or vertebral artery communicating branch between the abnormal vascular thrombosis often leads to failure. Through a summary of the patients in the treatment of nasal bleeding should do the following: ① nasal trauma caused by nasal bleeding, often due to skull fracture, do not blindly give nasal packing, and sometimes actually worsened the condition or cause of intracranial infection, should be identified in endoscopic damage, whether cerebrospinal fluid rhinorrhea, with or without the sphenoid sinus wall fractures and so on. ② to diagnosis in patients with nasal bleeding, the bleeding on the more fierce, it is best used in endoscopic suction, while attracted to the site of bleeding edge search to identify the bleeding site, the available microwave, laser, bipolar electrocoagulation, packing, etc. to stop bleeding. ③ middle turbinate above the lower edge of the site of bleeding, the use of such method is invalid, can be used for screening artery ligation. ④ of mucosal erosion, repeated bleeding, and should not be above the line when the connective tissue sheet from the body of the affected area with a biological glue, can receive good results. ⑤ bleeding site can not be ascertained, the line DSA inspection, if not found responsible blood vessel, artery embolization should not be done.