Electric Coagulation And Nasal Packing Under Nasal Endoscopic To Treat Intractable Epistaxis

Epistaxis is common and frequently occurring diseases in ENT clinical work, the majority of nasal bleeding by local chemical cauterization, electrocoagulation, laser, freezing or nasal packing and hemostasis. However, in some intractable epistaxis by packing or vascular ligation of the method is still unable to stop the bleeding.With the endoscopic clinical applications in ENT, for the treatment of refractory bleeding has provided technical means, through the endoscopic imaging system, can understand the situation of the nasal epistaxis and bleeding points, looking to carry out targeted bleeding to reduce the blindness of traditional nasal packing, reduce the suffering of patients. This study on a large sample of endoscopic coagulation therapy combined with nasal packing cases of intractable epistaxis, compared with traditional methods of nasal packing in patients with postoperative bleeding, pain, and complications from surgery, the recovery of patients with nasal mucosa, nasal packing comparison, the assessment of endoscopic coagulation therapy combined with nasal packing the feasibility of intractable epistaxis, to guide and make more effective clinical treatment program.ObjectiveAnalyzed and summarized Endoscopic electrocoagulation combined with local treatment of refractory epistaxis packing the strengths and weaknesses, assess the endoscopic coagulation efficacy.MethodsSelect from August 2006 to August 2009 to three years of Shandong Province Hospital in Otorhinolaryngology admitted 109 patients with refractory epistaxis cases confirmed by endoscopic find burning bleeding and coagulation, in some cases combined calcium alginate dressing local packing treatment, and 20 patients treated with traditional nasal packing cases of intractable epistaxis compared blood loss, postoperative complications, postoperative patient comfort and recovery of the nasal cavity.ResultEndoscopic hemostasis of 109 patients with refractory epistaxis, one underwent a second endoscopic hemostasis cured; 2 patients endoscopic maxillary sinus disease was found, after the selection of cured via endoscopic sinus surgery; one case patients relapsed after 2 months again Endoscopy showed that the olfactory cleft hemangioma, to the removal of cure. The remaining 105 cases treatment is effective, were followed up for 2 months had no recurrence.Nasal packing group of 20 patients in seven cases of nasal packing removed from the nose after the attack did not re-bleeding,11 cases of repeated 2-3 times before and after nasal packing to stop bleeding and more, two cases of nasal packing material removed after the repeated massive bleeding, nasal Endoscopic coagulation cure.Endoscopic coagulation of the average blood loss and postoperative complication was significantly less than the nasal packing group, and the course of treatment in patients with pain, nasal mucosa after nasal ventilation recovery and recovery time was much shorter.Group of 109 cases of endoscopic hemostasis in patients following nasal bleeding site (more than in the fornix) 38 (34.86%), posterior nasal septum in 25 cases (22.94%), middle meatus in 18 cases (16.51%), nasal septum ago upper (anterior ethmoid artery distribution) in 17 cases (15.60%), and butterfly screen crypt olfactory cleft in 11 cases (10.09%).ConclutionFor refractory epistaxis, endoscopic examination revealed the common bleeding sites were:inferior meatus, nasal septum in the rear, middle meatus, nasal septum before the upper part of the olfactory cleft and butterfly screen recess, rather than the nose-nose pharyngeal plexus (Wu vein area). Nasal endoscopy in the Wu area found no obvious expansion of vascular area. Endoscopic electrocoagulation combined with nasal packing for refractory partial nasal bleeding, pain, fewer complications and quicker recovery, patient comfort is good, worthy of promotion. Objective:to reduce the monostrosity rate and to investigate the treatment of auricular traumatic injuries.Method:all patients were treated by different operative methods and negative pressure drainage, local heparinization after operation according to various severity of injuries.Result:the result were satisfied.Conclusion: negative pressure drainage, and heparinization can conduce to reablement of the auricular traumatic injuries.