选择性咯血责任动脉栓塞术在治疗大咯血中的临床应用  

Clinical effectiveness of responsible arteries embolisation for the management of haemoptysis

作　　者：黄鹤[1] 李斌[1] 周华[1] 闫小彬[1] 孙鹏[1] 褚建国[1] 时惠平[1] 

机构地区：[1]中国人民解放军空军总医院放射科,北京100142

出　　处：《医学影像学杂志》2016年第2期243-246,共4页Journal of Medical Imaging

摘　　要：目的评价选择性支气管动脉和肺外体循环动脉栓塞术治疗大咯血的即刻和长期疗效,并探索影响咯血栓塞疗效的因素。方法回顾性分析25例行选择性动脉栓塞治疗大咯血的患者的血管造影及病史。所有患者均经股动脉插管至靶动脉行选择性动脉栓塞术进行止血。结果咯血的病因包括结核(20%)、支气管扩张(16%)、特发性(16%)、曲霉菌感染(12%)、NSCLC(12%)、肺炎(12%)和其它原因(12%)。25例咯血患者经支气管动脉造影均明确了咯血责任动脉,共计栓塞63支支气管和肺外体循环动脉。经栓塞治疗后25例患者出血均即刻停止。18例(72%)患者的咯血获得了长期有效控制,7例(28%)患者在6个月内再发咯血。曲霉菌感染患者的预后结果最不理想,所有3例均再发咯血,其中1例死于大咯血。曲霉菌感染与咯血再发风险呈正相关联(P<0.05)。并发症发生率较低,有短暂胸痛、低热等栓塞后综合征,无脊髓损伤。结论选择性动脉栓塞术对大咯血患者是有效、安全、可行的诊断、控制措施,但在曲霉菌病例中存在较高的咯血再发率和死亡率,必要时需再次栓塞。Objective To evaluate the immediate and long-term results of arterial embolisation in the management of haemoptysis and to identify factors influencing outcome. Methods A retrospective analysis was carried out of the medical records and angiograms of 25 patients who underwent transarterial embolisation for haemoptysis. Results The causes of haemoptysis included tuberculosis（ 20%）,bronchiectasis（ 16%）,idiopathic（ 16%）,aspergilloma（ 12%）,non-small cell lung cancer（ 12%）,pneumonia（ 12%）,and others（ 12%）. A total of 63 bronchial and non-bronchial systemic arteries were embolised and immediate cessation of haemoptysis was achieved in all patients. Haemoptysis was controlled in 18 patients（ 72%）,recurred in 7（ 28%） during 6 months. The worst outcomes were observed in patients with aspergilloma： all three suffered recurrent bleeding and 1（ 33%） died from massive haemoptysis. Aspergilloma was also associated with an increased risk of haemoptysis recurrence（ P〈0. 05）. Complication rates were low and included transient chest pain,fever,and no injury of spinal cord. Conclusion Selective arterial embolization is an effective,safe and feasible procedure for haemoptysis control in most cases. However,high recurrence and mortality rates are associated with aspergilloma,embolization should be done again if necessary.

关 键 词：咯血 选择性动脉栓塞术 支气管动脉 肺外体循环动脉 

分 类 号：R563.6[医药卫生—呼吸系统] R815[医药卫生—内科学]