摘要
目的探讨逐级多重栓塞治疗顽固性大咯血的技术要点和临床疗效。方法回顾性分析采用个体化逐级多重栓塞法治疗的103例顽固性大咯血患者资料。通过造影明确责任血管的类型、数量、异常分支、肺循环和（或）肺周体循环分流情况后，结合疾病类型，以聚乙烯醇颗粒、海藻酸钠微球作为基础栓塞剂行个体化逐级多重栓塞治疗。术后根据患者咯血症状的改善情况判定早期（术后〈3个月）、中期（术后3～6个月）和远期（术后〉6个月）疗效。采用Kaplan—Meier生存曲线对个体化逐级多重栓塞法治疗顽固性大咯血的疗效进行评价。根据责任血管供血特点将患者分为伴体．肺循环分流（SPS）组和无SPS组，并采用Log．Rank检验比较2组患者的1年有效率。结果103例患者共检出责任血管215支，其中196支行个体化逐级多重栓塞，8支行末梢栓塞治疗，11支行主干明胶海绵颗粒栓塞。103例患者术后随访6～50个月，中位随访时间21个月。即刻止血率为97．1％（100／103）。患者1、3、6个月及1、2、3年的有效率分别为94．5％、93．2％、89．7％、88．9％、85．2％和76．6％。103例中，伴SPS组患者22例，无SPS组患者81例。伴SPS组和无SPS组患者的1年有效率分别为（69．50±0．11）％和（98．30±0．03）％，差异有统计学意义（χ2=11．662，P〈0．01）。结论采用个体化逐级多重栓塞法治疗顽固性大咯血具有较好的近期和中远期疗效。
Objective To explore main technical points and clinical efficacy of individualized stepwise multiple embolization treatment for refractory hemoptysis. Methods To retrospectively analyze materials of 103 patients treated by individualized stepwise multiple embolization. According to disease categories, individualized stepwise multiple embolization treatment with polyvinyl alcohol and loaded sodium alginate microspheres as basic embolization agent were performed, after the type, number, abnormal branches, pulmonary circulation and systematic pulmonary shunt of targeted vessels were confirmed through radiography. To judge short（less than 3 months）, medium（3 to 6 months） and long term（more than 6 months） efficacy, resolution of hemoptysis after operation were assessed. To evaluate efficacy of individualized stepwise multiple embolization treatment for refractory hemoptysis, Kaplan-Meier survival curves were used. According to the features of target vessels to supply blood, patients were classified into with SPS and without SPS. By using Log-Rank test, the effective rates of one-year were compared between them. Results Out of 103 patients, 215 target vessels were demonstrated, among which individualized stepwise multiple embolization was for 196 target vessels, peripheral embolization for 8 vessels, and main trunk embolization in 11 patients. The visits after operation were made to 103 patients after 6 to 50 months, with the medium of 21 months. Hemoptysis was instantly resolved in 97.1% （100/103）. The effective rates were 94.5%,93.2%, 89.7%,88.9%,85.2% and 76.6% for one, three, six months and one, two and three years after operation. In 103 patients, patients with SPS were 22 and without SPS were 81. One-year effective rates with and without SPS were （69.50 ± 0.11）% and （98.30± 0.03）% , respectively （x2=11.662,P〈0.01）. Conclusion Individualized stepwise multiple embolization treatment shows excellent short-term and mid-long term efficacy in the treatment of refractory hemoptysis.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2015年第8期605-609,共5页
Chinese Journal of Radiology
关键词
咯血
支气管动脉
栓塞
治疗性
Hemoptysis
Bronchial arteries
Embolization,therapeutic
