후방 비출혈의 위험 인자 및 접형구개동맥 결찰술 실패요인 분석

Abstract

Background and Objectives Most cases of epistaxis can be controlled by conservative management such electrocautery or nasal packing. However, for some cases of the posterior epistaxis, invasive procedures like endoscopic sphenopalatine artery ligation (SPAL) or arterial embolization are needed. In this study, risk factors present in patients who were hospitalized due to posterior epistaxis and postoperative complications and causes of recurrence after SPAL were analyzed. Subjects and Method A retrospective chart review of 75 patients who were admitted to Gyeongsang National University Hospital for the treatment of posterior epistaxis between 2009 and 2014 was performed. Demographic factors, seasonal variation, comorbid diseases, and laboratory results were analyzed. Furthermore, 35 patients who have undergone SPAL were surveyed by telephone regarding postoperative complications, and preoperative computerized tomography (CT) images were reviewed to figure out the causes of the recurrence after SPAL. Results Among 75 patients, 53 (70.7%) were males. Male preponderance (80%) was more definite among those who have undergone SPAL (p=0.04). Age over 40 as well as the winter season and the underlying disease such as hypertension were also critical risk factors for posterior epistaxis. Four out of 35 patients who had undergone SPAL showed recurrence. The bleeding was detected in the branches of sphenopalatine artery in three out of the four patients who experienced recurrent bleeding following SPAL, which were controlled by revision surgery or arterial embolization. Conclusion Posterior epistaxis occurred frequently in men over 40 years of age and in winter. A careful preoperative review of CT images and meticulous dissection during SPAL might be helpful for preventing recurrence after SPAL. Korean J Otorhinolaryngol-Head Neck Surg 2016;59(5):366-72