动脉硬化患者支气管动脉的介入治疗  

Bronchial artery interventional therapy in the patients with severe arteriosclerosis

作　　者：屈国林[1] 葛晶[2] 曲保田 李伟[4] 徐晓明[1] 陈学忠[1] 唐晖 强民 吕春燕[1] 杨淑惠[1] 

机构地区：[1]北京空军总医院放射科,北京市100036 [2]解放军463医院放射科 [3]空军招飞局北京选拔中心 [4]吉林油田总医院江北影像科 [5]空军招飞局济南选择中心

出　　处：《实用诊断与治疗杂志》2007年第4期262-264,I0001,共4页Journal of Practical Diagnosis and Therapy

摘　　要：目的:评价在动脉硬化严重、插管困难的支气管动脉破裂咯血患者中,超选择性支气管动脉插管的技术应用和治疗价值。方法:18例动脉硬化严重的患者中:肺癌11例,肺癌并支气管动脉破裂出血2例,支气管扩张咯血5例;采用Seldinger经皮穿刺技术,首先送入5F或6F型号的Cobra导管做支气管动脉造影,继选择微导管(SP导管、Magic导管)行超选择性支气管动脉病变分支造影,使用明胶海绵颗粒+超液化碘油和／或PVA颗粒栓塞剂栓塞。结果:18例患者超选择性插管栓塞均成功,术后咯血停止。对4例动脉硬化严重插管不能进入到支气管口部者,采取探出插管法获得成功。对1例78岁动脉硬化严重、病变血管不能超选插入者,尝试血管内膜损伤法、继发血栓形成栓塞获得成功。无严重并发症发生。经1～11年随访观察术前咯血者无再咯血发生,肿瘤患者得到较满意控制。结论:应用微导管技术,行超选择性支气管动脉插管,采用明胶海绵+超液化碘油和／或PVA的介入方法,特殊情况下用导丝或微导管探出插管法、栓塞用血管内膜损伤法栓塞,对治疗动脉硬化严重支气管动脉破裂咯血和肺癌的患者是行之有效的。Objective to study the technique and evaluate the therapeutic effectof super-selective bronchial artery embolization in patients with severe arteriosclerosis or hemoptysis caused by rupture of bronchial artery. Methods Eighteen cases suffered from severe arteriosclerosis, in which 11 were lung cancer, 2 were lung cancer with rupture of bronchial artery and hemoptysis, and 5 were bronchiectasis with hemoptysis. Seldinger technique was employed, bronchial arteriography was performed using 6F or 5F cobra catheter followed by super-selective arteriography of bronchial artery with microcatheter （SP catheter, Magic catheter）. The embolic agents used were gelfoam particles＋ hyperliquified iodiged iodized oil/and PVA particles. Results The successful catheterization was achieved in all cases. Hemoptysis stopped after the procedure. In 4 cases due to severe arteriosclerosis, the catheter failed to enter the bronchial artery orifice by the routine approach. The protruding catheterization technique was used and the procedure was successfully finished. In a 78- year old patient with severe arteriosclerosis, while superselective catheterization was not possible, endothelial trauma induced thrombosis was attempted and the embolization obtained successful. All were followed up from 1 to 11 years, showing that hemoptysis was completely controlled. Good palliation was obtained in patients with lung cancer. Conclusion Microcatheter, superselective bronchial artery catheterization gelfoam ＋ hyperliquified iodized oil or/and PVA interventional therapy, protruding catheterization technique and endothelial trauma induced thrombosis, are effective for the patients with severe arteriosclerosis and hemoptysis due to rupture of bronchial artery and with lung cancer.

关 键 词：动脉硬化 支气管动脉 咯血 栓塞 治疗 

分 类 号：R543[医药卫生—心血管疾病]