“三明治”式支气管动脉栓塞术治疗咯血的临床疗效分析  

Bronchial artery embolization in ‘sandwich' pattern for the management of hemoptysis:analysis of clinical effectiveness

作　　者：丁健[1,2] 王永利[2] 王征宇[2] 刘利珍[2] 陈锦琼[2] 彭志清[2] 

机构地区：[1]苏州大学医学部 [2]上海交通大学附属第六人民医院南院介入放射科,201400

出　　处：《介入放射学杂志》2014年第3期245-249,共5页Journal of Interventional Radiology

摘　　要：目的探讨“三明治”式支气管动脉栓塞术（BAE）治疗咯血的临床疗效。方法收集2010年3月-2012年3月进行BAE治疗的30例不同程度的咯血患者，术后对所有病例进行为期1～3年的追踪随访。用SPSS17．0统计软件对咯血复发率、远期控制率进行估算，并分析BAE治疗方法、咳血复发原因及治疗措施等。结果“三明治”式BAE后止血的即刻有效率100％（30／30），有效率30．0％（9／30），治愈率63.3％（19，30），复发率为6．7％（2／30），对咯血的1年控制率和估计2年控制率均为76％和68％，本组病例中2例需要再次进行支气管动脉栓塞治疗，造影显示1例为漏栓责任血管（时间距上次手术时间为8d），另1例为原左侧已栓塞支气管动脉再次开放，血管增粗、扭曲（距上次栓塞时间为7个月），2次栓塞后病变血管均未再显影，患者停止咯血且未复发。结论“三明治”式支气管动脉栓塞术治疗大咯血安全、有效，咯血复发的主要原因为漏栓及侧支循环的形成。Objective To investigate the clinical effectiveness of bronchial artery embolization（BAE） in ＇sandwich＇ pattern for the management of hemoptysis. Methods During the period from March 2010 to March 2012, a total of 30 patients with hemoptysis were admitted to authors＇ hospital. BAE in ＇sandwich＇ pattern was carried out in all patients. All patients were followed up for 1 - 3 years. The recurrence rate and long-term disease control rate were estimated with SPSS versionl 7.0 software. The BAE method, causes of recurrent hemoptysis and the therapeutic measures were discussed. Results The immediate hemostasia rate of ＇sandwich＇ pattern BAE was 100% in all patients. Efficiency rate, Cure rate and recurrence rate was 30.0%（9/30）, 63.3% （19/30） and 6.7%（2/30） respectively. The control rate of hemoptysis was 76% and 68% for 1 year and 2 years respectively. Hemoptysis recurred in two patients during one year following-up period. Angiography showed that in one case an offending vessel remained patent without being embolized （8 days after initial operation）, and that in another case the initially embolized left bronchial artery opened again （7 months after initial operation）. Hemoptysis did not recur after the two patients underwent the second BAE. Conclusion For the treatment of massive hemoptysis, the ＇sandwich＇ pattern bronchial artery embolization is safe and effective. Recurrence of hemoptysis may attribute to the missing embolization of the feeding vessels or the formation of collateral circulations.

关 键 词：咯血 支气管动脉 栓塞 

分 类 号：R563.6[医药卫生—呼吸系统]