选择性支气管动脉栓塞在治疗大咯血中的应用  

Application of Selective Bronchialartery Embolization on Treating Severe or Repeated Hemoptysis

作　　者：涂力[1] 温桂兰[1] 辜斌[2] 黄立新[2] 肖声平[3] 曾清华[1] 刘琴[1] 

机构地区：[1]南昌大学第一附属医院呼吸内科,南昌330006 [2]南昌大学第一附属医院放射科,南昌330006 [3]南昌大学第一附属医院急诊科,南昌330006

出　　处：《江西医学院学报》2009年第10期32-34,49,共4页Acta Academiae Medicinae Jiangxi

基　　金：江西省教育厅科学技术研究项目--重点项目(赣教技字[200678]号)

摘　　要：目的探讨支气管动脉栓塞(BAE)治疗大咯血的疗效,并进一步分析不同栓塞材料对BAE临床疗效的影响。方法经内科治疗无效行BAE治疗的大咯血患者42例,采用Seldinger技术经皮股动脉穿刺插管,行支气管动脉造影术,根据造影明确出血的供血血管后选择明胶海绵颗粒联合明胶海绵条(A组,n=23)或明胶海绵颗粒联合弹簧钢圈(B组,n=19)进行栓塞治疗。所有患者进行至少6个月的随访,观察2组患者术后即时、近期、中远期疗效。结果42例患者均成功栓塞病变支气管动脉,技术成功率为100%。2组患者即刻止血效果满意,总有效率均为100%。术后随访6个月～3年,A组、B组患者近期止血总有效率分别为95.7%、100%,中远期止血总有效率为73.9%、100%。6例复发者均为A组患者,其中5例经内科保守治疗止血,1例外科手术止血。结论BAE治疗大咯血高效、安全、操作简便。与单纯明胶海绵联合栓塞相比,联合应用弹簧钢圈和明胶海绵颗粒治疗大咯血的复发率更低。Objective To evaluate the effectiveness of bronchialartery embolization for the management of hemoptysis,and compare the clinical value of the embolic agents being used.Methods Fourty-two patients were performed by Seldinger puncture technique through femoral artery.The arteries supplied the lesion responsible for hemoptysis were confirmed by bronchial arteriography.Then the arteries were embolizated with gelatin sponge and stainless steel platinum coils.They are divided into two groups：group A （joint gelatin sponge tent gelatin sponge particles group,n=23）,group B （joint stainless steel platinum coils,gelatin sponge group,n=19）.These patients were followed up for at least 6 months and were observed immediate,recent and the long-term efficacy.Results Fourty-two patients were succeed in embolizing pathological bronchialartery,the success rate of technology was 100%.The immediate stop bleeding effect of two groups patients is satisfied,the total effective rate was 100%.The patients were followed up for 6 months to 3 years.The short-term total effective rate of hemostasis of patients was 95.7%,100% respectively,and long-term total effective rate was 73.9%,100% respectively.Six cases of recurrence are gelfoam alone,of whom five cases of recurrence were treated by conservative medical methods to stop bleeding,the other case was surgery treatment.Conclusion It is showed that BAE is a safe,simple and high effective method in controlling hemoptysis.It proved that the combination of stainless steel platinum coils and gelatin sponge particles for bronchial artery embolization can be significantly reduced the relapse rate of massive hemoptysis.

关 键 词：大咯血 支气管动脉栓塞 明胶海绵 钢圈 

分 类 号：R441.7[医药卫生—诊断学]