摘要
目的 探讨经导管支气管动脉栓塞 (TBAE)治疗大咯血后复发的原因及预防措施。资料与方法 5 6例咯血患者接受TBAE治疗 ,其中支气管扩张 38例 ,肺结核 7例 ,肺癌 6例 ,肺切除术后咯血 4例 ,支气管动静脉畸形1例。咯血量 15 0～ 70 0ml。 5 6例共栓塞靶血管 79支 ,其中单纯使用明胶海绵颗粒 (GSP)栓塞 4 1例 ,使用GSP +丝线线段栓塞 4例 ,使用GSP +无水乙醇栓塞 3例 ,使用GSP +聚乙烯醇 (PVA)栓塞 4例 ,单纯使用PVA栓塞 4例。所有病例随访 1年以上 ,对有咯血复发的病例均重复行DSA及栓塞治疗。结果 5 6例患者TBAE后 30min～ 4h咯血均完全停止 ,但栓塞后 1周、1个月、6个月和 1年分别有 7例 (12 .5 % )、10例 (17.9% )、12例 (2 1.4 % )和 13例(2 3.2 % )复发。复发的原因包括支气管动脉再通 (5例 )、支气管动脉漏栓 (3例 )、非支气管动脉供血 (3例 )和原发病进展 (2例 )。采用长效栓塞剂联合栓塞 ,寻找多支支气管动脉及参与供血的膈动脉、肋间动脉、胸廓内动脉等非支气管动脉并予以栓塞 ,积极治疗原发病是预防咯血复发的主要措施。
Objective To investigate the causes and preventions of recurrence in hemoptysis after transcatheter bronchial artery embolization (TBAE). Materials and Methods Fifty-six patients with hemoptysis were treated with TBAE. The related diseases included bronchiectasis (n=38), pulmonary tuberculosis (n=7), pulmonary carcinoma (n=6), pulmonectomy (n=4) and bronchial arteriovenous malformation (n=1). The amount of hemoptysis was 150～700 ml. In the total 56 cases, 79 target arteries were embolized, of which gelatin sponge particles (GSP) alone was used in 41, GSP together with silk thread in 4, GSP plus ethanol in 3, GSP with PVA in 4 and only PVA in 4. All the patients were followed up for over one year. DSA exam and TBAE were repeated in the recurrent patients. Results In all the patients, the hemoptysis was stopped completely in 1/2～4 hours after the procedure. At one week, 1, 6 and 12 months after TBAE, hemoptysis recurred in 7, 10, 12 and 13 cases, respectively. The causes of recurrence included reopening of the embolized bronchial artery (n=5), missing embolization of diseased bronchial artery (n=3), non-bronchial feeding artery (n=3) and deterioration of the primary disorders (n=2). The main measures to prevent recurrence of hemoptysis were as follows: (1) using GSP together with long-term embolic agents; (2) making great effort to search the lesion's feeding arteries, including phrenic, intercostal, intrathoracic, etc. arteries; (3) enhancing the treatment of the primary diseases.Conclusion A knowledge of the causes of recurrence in hemoptysis after embolization treatment is of great help for its prevention.
出处
《临床放射学杂志》
CSCD
北大核心
2004年第4期336-339,共4页
Journal of Clinical Radiology
