Nosebleeds are one of the most common emergencies in otolaryngology head and neck surgery. The nose is rich in blood vessels and thin in mucous membranes, so accidental trauma and nasal lesions can lead to epistaxis. Studies have shown that about 90% to 95% of nosebleeds are caused by the Li’s area at the front of the nasal septum. Most of the bleeding can be effectively stopped by measures such as anterior nostril packing; the remaining 5% to 10% of nosebleeds are located in the deep nasal cavity, due to poor visibility and poor visibility. The site is deep, and it is difficult to find the bleeding site. Conventional packing is difficult to control, making the diagnosis and treatment relatively difficult. This type of epistaxis can be classified as refractory epistaxis. With the aging of society, the incidence of refractory epistaxis continues to rise.
Refractory epistaxis has the characteristics of repeated disease and a large amount of bleeding. It is difficult to diagnose the bleeding site by conventional examination methods. Due to the complex structure of the nasal cavity, the bleeding site is hidden. If the bleeding site cannot be accurately determined, only the traditional packing method is used for treatment. The compression and hemostasis is not thorough enough, and the blindness is large. The process is more painful. Especially in the elderly, bilateral nasal cavity and posterior nostril packing can even lead to damage to their cardiopulmonary function. Therefore, refractory epistaxis has become one of the difficult problems in clinical treatment.
Under the limitation of this unfavorable condition, the minimally invasive treatment of refractory epistaxis under nasal endoscopy came into being. The exploration of the bleeding site under nasal endoscopy has the advantages of wide field of view and clear images, and it is easier to observe the bleeding site clearly. It is widely used in clinical practice. Nasal endoscopic bipolar coagulation hemostasis, endoscopic sphenopalatine artery ligation, etc. are all effective means of hemostasis.
Especially, endoscopic ligation of the sphenopalatine artery has become widely regarded as a safe and effective measure for the treatment of posterior nose bleeding. (Draft)” is listed as one of the important means of treating epistaxis. The sphenopalatine artery is the terminal branch of the maxillary artery in the nasal cavity, and it is also the main artery supplying blood to the nasal cavity. It can provide about 80% to 90% of the blood supply to the entire nasal cavity. One of the foundations, as early as 1963, Malcomson advocated the method of sphenopalatine artery ligation, and proposed that when tamponade could not prevent nasal bleeding, surgical ligation of the sphenopalatine artery could be used as an auxiliary means, which is also the treatment of nasal sphenopalatine artery ligation. Bleeding came into the public eye for the first time. After decades of development, the technology of endoscopic sphenopalatine artery ligation in the treatment of epistaxis has become more and more mature. Studies at home and abroad have shown that the effective hemostasis rate of endoscopic sphenopalatine artery ligation is 77% to 100%. ! Sphenopalatine artery ligation in the treatment of refractory epistaxis has been proved by numerous cases: its theoretical support is sufficient, the anatomical structure is fixed, the clinical operation is simple, and the effect is reliable. It is an effective means for the treatment of refractory epistaxis.
Shandong Otolaryngology Hospital Rhinology Center, under the leadership of Director Ji Hongzhi since 2014, took the lead in the province to carry out endoscopic sphenopalatine artery electrocoagulation in the treatment of refractory More than 400 cases of epistaxis have become routine operations in the department. There is no need for nasal filling after operation, which greatly reduces the pain of patients, and avoids the arterial embolization operation of femoral artery cannulation in some patients. So far, tens of thousands of patients have been treated, and satisfactory results have been achieved, and it is gradually promoted in primary hospitals in the province.
Shandong Otolaryngology Hospital Rhinology Center reminds everyone that if there is nosebleed, you can take simple measures such as ice cubes and cold compresses on the nose and face, continuous pressure on the nose or filling with sterile cotton balls. If the bleeding cannot be stopped, you must go to the hospital in time and ask a professional doctor for treatment.