摘要
目的:分析大咯血支气管动脉造影改变,评价支气管动脉栓塞治疗大咯血即刻及中远期临床疗效。方法:对32例内科难治性大咯血施行支气管动脉栓塞术,术前常规行胸主动脉造影及选择性、超选择性支气管动脉造影。所有病例均联合使用明胶海绵及PVA(polyvinyl alcohol particles)颗粒栓塞,其中2例术中联合使用不锈钢圈,回顾性分析其临床及影像资料。结果:支气管动脉造影表现:支气管动脉增粗、迂曲(100%),支气管动脉肺动、静脉瘘(41%),假性动脉瘤(15%),造影剂外溢(22%)。4例非支气管动脉(3例肋间动脉、1例内乳动脉)参与病变供血。栓塞术后1-2周观察即刻止血效果,31例(97%)患者咯血停止,1例患者栓塞术后咯血量未见减少,复查造影见有肋间动脉参与病变供血,行肋间动脉栓塞术后咯血量明显减少。所有栓塞病例术中、术后均未观察到明显并发症及不良反应。1例患者术后1月内早期复发,其余30例患者术后追踪观察6-24月,8例再发咯血,复发率29%,3例行再次经皮支气管动脉栓塞术成功止血。结论:大咯血患者支气管动脉造影多表现为支气管动脉血管异常,非支气管动脉出血可能。经皮支气管动脉栓塞术治疗内科难治性大咯血是安全有效的,联合使用栓塞材料能保证栓塞效果。
Objective： To analyze massive hemoptysis bronchial arteriography change and evaluate immediately and long- term clinical efficacy of bronchial artery embolization for massive hemoptysis. Methods： 32 cases of medical refractory hemoptysis were performed bronchial artery em- bolization. Thoracic aortic angiography and selective bronchial arteriography was performed before the procedure in order to evaluate the characteristic of the feeding artery. Fanbolism maierials was used a combination of gelatin sponge and PVA （polyvinyl alcohol particles） particles . The clinical data and imaging findings were retrospectively analyzed. Results： Bronchial arteriography performance： bronchial artery thickening, tortuosity （100%）, arterio- venous fistula （41% ）, pseudoaneurysms （ 15 % ）, contrast agent extravasation （22 % ）. Four cases of non- bronchial artery （3 cases inter- costal artery, 1 case of internal maaanary artery） is involved. 1 - 2 weeks after embulization observed immediate hemostasis effect, 31 cases （97%） patienis with hemopiysls stop, no reduction of one cases . The review imaging showed intercostal artery angiography were seen in lesions blood sup- ply. After performed iniercostal artery embolization, hemoptysis were significantly reduced. No obvious complications and adverse reactions were ob- served. One palient early recurrence after one month. The remaining 30 patients, postoperative follow- up observation 6 - 24 months. Recurrent hemopiysis 8 cases, the recurrence rate was 29%, Percutaneous bronchial artery embolization successful hemostasis in 3 cases. Conclusion： Bronchial arteriography of hemoptysis much performance for bronchial artery vascular abnormalities, non- bronchial arterial bleeding may. Percuta- neous bronchial ariery embolization for the treatment of refractory massive hemoptysis is safe and effective. Use a combination of embolism materials can guaraniee embolization effect.
出处
《内蒙古中医药》
2013年第4期9-11,共3页
Inner Mongolia Journal of Traditional Chinese Medicine
