摘要：

目的 总结经鼻内镜颅底手术后严重鼻出血的原因与治疗方法。方法与结果 选择2007 年 2 月至 2018 年 1 月经鼻内镜颅底手术后发生迟发性鼻出血的患者共 12 例，经内镜下电凝止血术（7 例）、DSA 辅助内镜下电凝止血术（1 例）、DSA 辅助超选择性动脉栓塞术（3 例）和 DSA 辅助超选择性动脉栓塞术联合内镜下电凝止血术（1 例）等外科手术治疗，11 例成功止血、1 例死亡；平均随访（17.21 ± 3.42）个月，无复发。结论 经鼻内镜颅底手术后鼻出血主要发生于术后 > 7 ~ 14 d，手术方式与出血部位和责任动脉有关。内镜下电凝止血术效果良好，且无严重并发症；颈内动脉假性动脉瘤形成患者可通过内镜下电凝止血术联合动脉栓塞术治愈。 

关键词: 内窥镜, 颅底, 鼻出血, 外科手术, 手术后并发症

Abstract:

Objective To summarize the causes, treatment and prognosis of severe epistaxis after transnasal endoscopic skull base surgery. Methods and Results There were 12 patients with delayed severe epistaxis after transnasal endoscopic skull base surgery from February 2007 to January 2018. Surgical methods included endoscopic electrocoagulation hemostasis in 7 cases (7/12), DSA-assisted endoscopic electrocoagulation hemostasis in one case (1/12), DSA-assisted superselective arterial embolization in 3 cases (3/12), and DSA-assisted superselective arterial embolization combined with endoscopic electrocoagulation hemostasis in one case (1/12). Successful hemostasis occurred in 11 cases, and one case died. Patients were followed up for (17.21 ± 3.42) months without epistaxis recurrence. Conclusions Epistaxis mainly occurs over 7 to 14 d after transnasal endoscopic skull base surgery. The choice of operation methods is related to the location of bleeding and responsible artery. Endoscopic electrocoagulation hemostasis is an effective method without serious complications. Patients with internal carotid artery (ICA) pseudoaneurysms can be cured by endoscopic electrocoagulation hemostasis plus arterial embolization.

Key words: Endoscopes, Skull base, Epistaxis, Surgical procedures, operative, Postoperative complications