急诊血管内栓塞治疗隐源性大咯血  

Emergency endovascular embolization for the treatment of cryptogenic massive hemoptysis

作　　者：张战利[1] 杨瑞民[2] 肖刚 王建利[1] 葛永强[4] 张铭秋[2] 

机构地区：[1]河南省新乡市第一人民医院介入科,新乡453000 [2]新乡医学院第一附属医院介入科 [3]新乡市妇幼保健院放射科 [4]新乡市第一人民医院CT室

出　　处：《临床医学》2014年第8期7-8,共2页Clinical Medicine

摘　　要：目的探讨血管内栓塞治疗隐源性大咯血的临床应用价值。方法对6例内科保守治疗无效的隐源性大咯血患者行超选择性支气管动脉栓塞(BAE),术中行主动脉造影。对支气管动脉(BA)和非支气管动脉(NBSA)进行评估,分析血管造影表现。随访观察BAE的临床效果及术后肺部CT表现。结果 6例患者中4例有吸烟史,血管造影共发现15支BA,肋间动脉3支。呈病理性改变11支,其主干增粗,可见血管末梢不同程度的增生,主干正常4支。所有患者BAE后即刻获得止血,随访时间内均未再发咯血,术后CT扫描未见异常。结论 BA是隐源性大咯血的主要责任血管,长期吸烟可能是导致隐源性咯血的主要因素,超选择性BAE治疗隐源性大咯血安全、疗效显著。Objective To investigate the clinical application value of endovascular embolization on cryptogenic massive hemoptysis. Methods Super selective bronchial artery embolization（ BAE） was given for 6 cases of cryptogenic hemoptysis with invalid internal medicine conservative treatment,and aortic angiography was performed during BAE. Bronchial artery（ BA） and nonbronchial systemic artery（ NBSA） was evaluated,and the angiographic signs were analyzed. The clinical effects and postoperative lung CT manifestations of BAE were observed. Results Among the 6 patients,4 patients had smoking history,15 bronchial arteries were found by angiography,3 intercostal arteries were found. Eleven systemic arteries with pathologic changes were found,with enlarged trunk and visible different degrees of hyperplasia of peripheral blood vessels,4 normal trunks were found.All patients had hemostasis immediately after BAE,and there was no recurrence of hemoptysis during the follow-up. Postoperative CT scan did not show any abnormalities. Conclusion Bronchal arteries are the primary feeding vessels in cryptogenic hemoptysis,and long-term smoking is one of the main risk factors for cryptogenic hemoptysis,super selective BAE is effective and safe for treatment of cryptogenic hemoptysis.

关 键 词：咯血 栓塞 支气管动脉栓塞 吸烟 

分 类 号：R56[医药卫生—呼吸系统]