摘要
目的 了解选择性支气管动脉双重栓塞术治疗肺结核咯血的远期疗效 ,探讨术后咯血复发、影响该治疗技术疗效的主要原因。方法 对 5 0例行支气管动脉造影 +双重栓塞术的肺结核咯血患者进行为期 2年的疗效追踪观察 ,其中男 37例、女 2 3例 ;年龄 8～ 75岁 ,平均 4 7 6岁。对其中咯血复发病例确定复发原因并予病因治疗及疗效观察。结果 5 0例肺结核咯血患者术后 2年治愈31例 ,治愈率为 6 2 % ,总止血有效 4 7例 ,有效率为 94 %。术后短期内咯血复发 9例 ,咯血复发的主要原因是肺结核持续不愈、合并支气管扩张感染 ,漏栓和肺外体循环参与肺内病灶供血导致血管难以彻底处理等技术上的因素也是原因之一 ;中、长期咯血复发 10例 ,咯血复发的主要原因则是肺结核好转后空洞内继发真菌感染 (主要是曲菌球 )及肺结核再次复发。结论 选择性支气管动脉双重栓塞术在治疗肺结核咯血时远期疗效明显 ,可防止大咯血引发的危险 ,为治愈肺部结核病变争取时间 ,有利于患者安全好转。血管栓塞是一种非常有效的止血方法 ,但去除引起慢性炎症刺激的感染病因才能真正治愈肺结核咯血。
Objective To investigate the long-term effect and the key factors associated with relapse of double embolization of bronchial artery in patients with lung tuberculosis and hemoptysis. Methods Fifty patients with lung tuberculosis and hemoptysis receiving the radiography and double embolization of bronchial artery (BAG+BAE) had been followed up for two years. The causes for hemoptysis relapse was determined, followed by specific treatment, and the effect was evaluated. Among them, 37 were males, 13 females, with the age of 8-75 years(mean age 47.6 years). Results The 2 year follow-up showed that the cure rate and the effective rate were 62%(31/50) and 94%(47/50) respectively. In a short term after embolization, hemoptysis relapsed in 9 cases, the major causes being active tuberculosis and secondary bronchiectasis complicated with infection. Other responsible factors included missed-embolization of bronchial artery and remaining blood supply from systemic circulation . In mid and long term follow-up, hemoptysis relapsed in 10 cases, the major causes being secondary pulmonary mycotic infection and recurrence of tuberculosis. Conclusions The long term result of double embolization of bronchial artery in patients with lung tuberculosis and hemoptysis was significant. It could prevent the danger from massive hemoptysis, and therefore allows the medical therapy for tuberculosis.. Embolization of bronchial artery is effective for hemostasis, while etiologic therapy aimed at removing the infection leading to chronic inflammation is the cure for tuberculosis and hemoptysis.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2004年第7期442-445,共4页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
广州市科技攻关资助项目 ( 99 Z 10 2 0 4)
