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目的:探讨头面部外伤后迟发性鼻出血的病因、临床表现、诊断和治疗方案。方法:回顾性分析16例头面部外伤后迟发性鼻出血患者的诊治经过,患者均行DSA确诊,根据临床表现、影像学资料、随访资料,分析早期的诊断方法和最佳治疗方案。结果:14例患者为颈内动脉海绵窦段假性动脉瘤形成,出血量50~1 000ml,均行覆膜支架介入治疗;失明1例,出现视野缺损1例。另外2例患者为颌内动脉分支假性动脉瘤形成,伤后及伤后2周出血,出血量约200ml,行血管介入明胶海绵栓塞,术后无并发症发生。患者术后均无脑神经功能障碍并发症及再次鼻出血等发生,复查DSA未见假性动脉瘤复发。结论:头面部外伤后迟发性鼻出血主要由颈内动脉海绵窦段假性动脉瘤形成后破裂引起,颌内动脉动脉瘤也可引起迟发性鼻出血,CTA、MRA和DSA有助于早期确诊,血管介入治疗效果好。
Objective: To investigate the etiology, clinical manifestations, diagnosis and treatment of delayed nasal hemorrhage after head and facial trauma. Methods: The diagnosis and treatment of 16 patients with delayed nosebleed after head and facial trauma were retrospectively analyzed. The patients were diagnosed by DSA. According to the clinical manifestations, imaging data and follow-up data, the early diagnosis and the best treatment were analyzed. Results: Fourteen patients were formed pseudoaneurysm of cavernous segment of internal carotid artery with blood loss of 50-1 000ml. All patients underwent stent-graft treatment. One case had blindness and one had visual field defect. The other 2 patients were the pseudoaneurysm of the branch of the maxillary artery. The bleeding occurred 2 weeks after the injury and the bleeding was about 200ml. The blood vessel was inserted into the gelatin sponge and no postoperative complications occurred. No postoperative complications of cranial nerve dysfunction and reoccurrence of nasal hemorrhage occurred. No recurrence of pseudoaneurysm was observed in DSA. Conclusion: Delayed nasal hemorrhage after head and facial trauma is mainly caused by the rupture of the pseudoaneurysm of cavernous sinus segment of internal carotid artery. Aneurysm of the internal carotid artery can also cause delayed epistaxis. CTA, MRA and DSA are helpful to Early diagnosis, vascular interventional treatment effect is good.