经导管超选择性动脉栓塞治疗咯血145例临床分析  

Transcatheter Superselective Arterial Embolization for the Treatment of Hemoptysis: Clinical Analysis of 145 Cases

作　　者：曾国斌[1] 林龙潜[1] 卢鑫[1] 廖立安[1] 

机构地区：[1]广东省中山大学附属梅州医院介入科,514031

出　　处：《临床放射学杂志》2014年第5期765-768,共4页Journal of Clinical Radiology

摘　　要：目的回顾性分析超选择性栓塞支气管动脉（BA）和／或非支气管性体动脉（NBSA）在治疗咯血中的方法与疗效。方法145例经内科药物治疗未能控制的咯血患者，行系统的动脉造影，根据造影情况超选择性BA和／或NBSA插管，采用栓塞剂（明胶海绵、PVA颗粒、微弹簧钢圈等）行1—2次栓塞治疗，其中77．2％（112／145）行双重栓塞。术后随访观察临床疗效和并发症。随访时间3—46个月。结果造影阳性率97．9％（142／145），142例中69例（48．6％）发现与咯血相关的NBSA163支，包括有肋间后动脉76支、锁骨下及腋动脉的分支63支、膈下动脉13支、食管固有动脉9支、胃左动脉2支。咯血控制率91％（132／145），中远期复发率12．9％（17／132）。术后1例出现肺功能衰竭。结论系统的血管造影是发现咯血责任血管的重要方法，超选择性动脉栓塞术可有效控制咯血，双重栓塞、有效的原发病治疗有助于提高手术的远期疗效。Objective To evaluate the efficacy of super-selective bronchial artery （BA） and/or non-bronchial systemic artery （NBSA） embolization in treating hemoptysis. Methods A total of 145 patients with hemoptysis who failed to respond to medications were enrolled in this study. Systemic arteriography was performed in all patients. Based on the arteriographic findings, super-selective BA and/or NBSA embolization was carried out by using Gelfoam, PVA particles, micro spring steel coil, etc. as embolic agents. One or two times of embolization procedure was employed in each patient. Dual embolization procedure was adopted in 112 patients （77.2%）. All patients were followed up for 3 -46 months, and clini- cal efficacy and complications were recorded. Results Positive angiographie findings were observed in 97.9% of patients （ 142/145 ）. NBSA-related 163 bleeding arteries were detected in 69 of the 142 cases （48.6%） , including posterior intercostal artery （ n = 76 ） , subclavian and axillary artery （ n = 63 ）, inferior phrenic artery （ n = 13 ）, proper esophageal artery （ n = 9 ） and left gastric artery （ n = 2）. The control rate of hemoptysis was 91% （ 132/145 ）, and the mid-to-long term recurrence rate was 12.9% （17/132）. After the treatment, pulmonary failure occurred in one patient. Conclusion Systemic angiography is an important means to find out the responsible bleeding vessels for hemoptysis. Super-selective bron- chial artery embolization can effectively control the hemoptysis. Dual embolization procedure and effective treatment of the primary disease can help improve the long-term efficacy.

关 键 词：咯血 超选择性 动脉 栓塞 

分 类 号：R56[医药卫生—呼吸系统] R816.4[医药卫生—内科学]