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目的探讨隐蔽区鼻出血部位和出血灶的检诊及识别方法。方法对2005年1月-2007年10月收治的122例常规鼻镜检查未发现出血灶的鼻出血患者的出血部位、出血灶及疗效进行回顾性分析,内镜下认明出血部位及出血灶后分别采用电热烧灼术、微波凝固术及微创填塞法治疗。结果122例患者的鼻出血部位分别为:嗅裂48例(39·34%)、下鼻道20例(16·39%)、中鼻道6例(4·92%)、鼻中隔前上部5例(4·10%)、鼻中隔中部凸起的凹面28例(22·95%)、鼻中隔后端11例(9·02%)、总鼻道底部前端3例(2·46%)、咽鼓管隆突1例(0·82%)。所有患者中,113例(92·62%)出血灶明确,分别为粟粒样隆起50例(44·25%)、点状突起37例(32·74%)、血管痣7例(6·19%)、粗糙隆起19例(16·81%),采用激光、微波、电凝等方法止血;另有9例(7·38%)出血灶不明,采用局部定向填塞止血。122例中1次治愈106例(86·89%),经2次治愈16例(13·11%),随访1～2个月无复发。结论中、下鼻道侧后部及嗅裂等是隐蔽区鼻出血发生的常见部位,鼻内镜技术结合中、下鼻甲骨折移位以及不同隐蔽区鼻出血的血流特点对探查隐蔽区出血灶具有重要意义,明确出血灶后于内镜下采用个性化微创干预可有效控制鼻出血。
Objective To explore the detection and identification of nosebleed and hemorrhagic foci in the hidden area. Methods A retrospective analysis was performed on the bleeding site, bleeding site and curative effect of 122 patients with nasal hemorrhage who were treated in routine nasal examination from January 2005 to October 2007. The bleeding site and hemorrhage site were identified under endoscopy After the use of electrothermal cautery, microwave coagulation and minimally invasive method of treatment. Results 122 patients had epistaxis in 48 cases (39.34%), 20 (16.39%) in the inferior nasal passages, 6 (4.92%) in the middle nasal passages, 5 28 cases (22.95%) were concave in the middle part of nasal septum, 11 cases (9.22%) posterior end of nasal septum, 3 cases (2.46% 1 case of bulging carina (0.82%). Among all the patients, 113 (92.62%) had definite hemorrhage lesions, including 50 cases (44.25%) of miliary bulge, 37 cases (32.74%) of punctate protrusion and 7 cases of vascular nevus %), And 19 (16.81%) of them were roughed up. Hemostasis was achieved by laser, microwave, electrocoagulation and so on. Another 9 patients (7.38%) had unknown hemorrhage site. Among 122 cases, 106 cases (86.99%) were cured in one time and 16 cases (13.11%) were cured after 2 times. No recurrence was observed in 1 to 2 months follow-up. Conclusions The middle and inferior posterior nasal mucosa and olfactory fissure are the common sites of epistaxis in the hidden area. Nasal endoscopy combined with the flow of the middle and inferior turbinate fractures and the flow of epistaxis in different concealed areas can detect the hemorrhage in the hidden area Stove has important significance, clear hemorrhage after endoscopic use of personalized minimally invasive interventions can effectively control the nose bleeding.