支气管动脉-肺循环分流的不同处理方法及远期止血疗效  

Processing Methods and Long-Term Effect of Hemostasis with Bronchial Artery-Pulmonary Shunts

作　　者：付志刚[1,2] 张晓磷[1,2] 徐丽[1,3] 韩强[1,2] 李海涛[1,2] 亓小虎[1,2] 赵文江[1,2] 

机构地区：[1]三峡大学第一临床医学院 [2]宜昌市中心人民医院介入科,湖北宜昌443003 [3]宜昌市中心人民医院神经内科,湖北宜昌443003

出　　处：《临床放射学杂志》2015年第6期980-983,共4页Journal of Clinical Radiology

摘　　要：目的探讨采用不同类型栓塞剂及栓塞方式栓塞支气管动脉-肺循环分流（BPS）的安全性及远期疗效。方法搜集129例大咯血患者中经DSA造影证实伴有BPS的89例为研究对象。89例中伴有原发病支气管扩张68例,肺结核13例,其他8例。术前均行支气管动脉CT成像（CTBA）,依据CTBA行选择性支气管动脉造影。根据分流类型及分流量选用不同种类及规格的颗粒栓塞剂和（或）弹簧圈进行栓塞。其中,早期各型BPS丝线颗粒栓塞17例,早期中快速型BPS弹簧圈栓塞4例,后期各型BPS海绵颗粒栓塞19例,后期各型BPS PVA栓塞35例,后期分流量大伴快速型BPS弹簧圈＋PVA栓塞9例,后期分流量大伴快速型BPS弹簧圈＋海绵颗粒栓塞5例。术中严密观察血氧饱和度。栓塞成功标准：分流现象消失,靶血管闭塞。随访12-31个月。结果 89例中有56例非支气管体循环动脉（NBSA）参与供血,21例发现非支气管动脉-肺循环分流（NBSA-PS）。在DSA监视下均成功进行责任支气管动脉及NBSA栓塞治疗,术后即刻止血率100%,无脊髓损伤等严重并发症发生。随访中8例大咯血复发,复发时间1-15个月,发生率分别为丝线颗粒11.8%（2/17）,海绵颗粒10.5%（2/19）,弹簧圈100%（4/4）。结论支气管大咯血中各型BPS采用PVA颗粒或弹簧圈＋PVA栓塞责任血管安全性高,远期止血疗效最优。Objective To investigate the efficacy and safety with bronchial artery-pulmonary shunts through different embolic agent and methods of embolization. Methods 129 patients with massive hemoptysis in our hospital were received. 89 cases with bronchial artery- pulmonary shunts were conducted bronchial artery embolization（ BAE）,the embolic was included silk particles,spring ring particles,PVA,sponge particles. The efficacy and safety were analysised for different embolic in bronchial artery- pulmonary artery shunt treatment. Results 89 cases with hemoptysis induced by bronchial artery-pulmonary shunts were embolized successfully. There were 17 cases embolized by wire-particle previously,4 cases by coil,and later 19 cases by sponge particle,35 cases by PVA,9 case by coil ＋ PVA,5 case by coil ＋ sponge particles. The hemostasis rate was 100% postoperative,there were no obvious complications and 8 cases recurred during the follow-up. Conclusion The safety and optimal therapeutic effect with bronchial artery- pulmonary shunts was selected the appropriate diameter pva particles and（ or） coil embolization.

关 键 词：栓塞剂 支气管动脉-肺循环分流 大咯血 介入治疗 

分 类 号：R459.7[医药卫生—急诊医学] R816.4[医药卫生—治疗学]