内镜下经鼻蝶入路术后迟发鼻出血的临床特点分析

摘要

目的 分析内镜下经鼻蝶入路术后迟发鼻出血的临床特点.方法 选取2010年1月—2017年2月于新疆医科大学第一附属医院神经外科鞍区组行内镜下经鼻蝶入路术并出现迟发鼻出血患者13例,回顾性分析其出血时间、出血性质、出血原因、止血方法及效果、随访结果.结果 出血时间:1例发生于术后2 d内,10例发生于术后3~15 d,2例发生于术后16~21 d,平均出血时间为术后8.1 d.出血性质:10例为鼻腔活动性渗血,3例为鼻腔大出血.出血原因:12例为血管残端瘢痕脱落致蝶腭动脉及其分支出血,1例为克氏静脉丛出血.止血方法及效果:1例术后鼻腔出现大量出血及呼吸衰竭,未能行手术止血,后经抢救无效死亡;3例行内镜下鼻腔探查止血,9例行经股动脉全脑血管造影及血管栓塞术,均止血成功.随访结果:12例患者出院后平均随访7.6个月,均恢复良好,未发生再出血.结论 迟发鼻出血是内镜下经鼻蝶入路术后较少见的并发症之一,多发生于术后3~15 d,主要与蝶腭动脉及其分支损伤有关,可行内镜下鼻腔探查止血术或经股动脉全脑血管造影及血管栓塞术.%Objective To analyze the clinical features of postoperative delayed epistaxis after endoscopic endonasal transsphenoidal surgery. Methods From January 2010 to February 2017, a total of 13 postoperative delayed epistaxis patients underwent endoscopic endonasal transsphenoidal surgery were selected in the Saddle Area Disease Workgroup, Department of Neurosurgery, the First Affiliated Hospital of Xinjiang Medical University, the occurrence time, manifestations, causes of delayed epistaxis, hemostatic methods and effects, and follow-up outcome were retrospectively analyzed. Results Occurrence time:1 case occurred delayed epistaxis within 2 days after surgery, 10 cases occurred 3 to 15 days after surgery, 2 cases occurred 16 to 21 days after surgery, the mean occurrence time was 8.1 days after surgery. Manifestations: 10 cases performed as nasal active errhysis, 3 cases performed as nasal hematorrhea. Causes: 12 cases due to hemorrhage of sphenopalatine artery and its branches caused by scar falling off of vascular residual end, 1 case due to hemorrhage of Kiesselbach plexus. Hemostatic methods and effects: 1 case occurred nasal excessive bleeding and respiratory failure after surgery without capably successful surgical hemostasis, finally died after rescue; 3 cases received endoscopic endonasal exploration and hemostasis, 9 cases received transfemoral approach cerebrovascular angiography and vascular thrombosis, all of the 12 cases got successful hemostatic effects. Follow-up outcome: 12 cases averagely followed up for 7.6 months, all of them got good recovery without recurrence. Conclusion Postoperative delayed epistaxis is one of relatively rare complications after endoscopic endonasal transsphenoidal surgery, mainly occurred 3 to 15 days after surgery and caused by injury of sphenopalatine artery and its branches, that may treated by endoscopic endonasal exploration and hemostasis or transfemoral approach cerebrovascular angiography and vascular thrombosis.