颅底骨折并发鼻出血的诊治

目的通过研究颅底骨折并鼻出血的病理解剖基础,针对不同类型鼻出血制定治疗对策。方法回顾分析近10年收治的106例颅底骨折并发鼻出血的患者,所有患者均行颅底薄层CT扫描,部分患者行脑血管造影检查。从颅底相关解剖特征、临床表现及CT扫描结果分析,研究颅底骨折鼻出血病理分类及治疗方法。结果①血性脑脊液为主的鼻出血,骨折部位多基于筛板、额窦;106例中有92例,经传统的抗菌治疗,均治愈;②严重鼻出血,骨折部位多基于颈内动脉岩内岩上段骨管周围,骨折线涉及蝶窦,106例中有10例;③严重鼻出血伴大量脑脊液漏者,为前讲述两种骨折合并存在;106例中有4例。对于后2种情况,采用以鼻腔填塞止血及脑血管介入为主要措施的治疗对策,除1例颅脑损伤较重,在入院后24 h内死亡,余均治愈。结论CT检查及脑血管造影对分析病情,设计治疗方案,判断预后有重要参考价值。对于颅底骨折伴严重鼻出血,脑血管造影及栓塞技术的应用为该症的治疗提供了一个较为安全可靠的方法。

The treatment of massive nose bleeding caused by basal skull fracture

Objective After studying pathology anatomise foundation of basal skull fracture combined nosebleed, set down treatment countermeasure aimed at different types nosebleed. Methods Clinical materials of 106 cases of nose bleeding caused by traumatic basal skull fracture were reviewed. All of patients had done lamina CT scan of basal skull,part of patients had done DSA. The pathology classify and treatment measure of basal skull fracture combined nosebleed were investigated throught analyzing basal skull anatomise character, clinic exhibition and CT scan result. Results ①brain raphe liquid was the main form in the nosebleed, there were 92 cases whose the basal skull fracture place was found on sieve plate or forehead-sinus in the 106 cases, these cases were given traditional resist bacterium treatment, they were all cured. ②Those cases whose was severity nosebleed, the fracture position were mostly around bone duct of inner-carotid. The fracture line were related to sphenoid sinus, there were 10 cases in all the cases. ③ The cases whose were severity nosebleed companion mass cerebrospinal rhinorrhea, the treatment of the pre two types fractures were the packing of nasal cavity or choanae and brain blood vessel digital subtraction angiographic localization and embolization. All the patients healed＇ except one patient died in 24 hours because of serious brain trauma. Conclusion The CT chest and brain blood vessel digital subtraction angiographic localization were very important to analyse state, design treatment plan, estimate prognosis. The applications of brain blood vessel digital subtraction angiographic localization and embolization was an effective and safe method to control serious epistaxis from basal skull fracture.