两种支气管动脉栓塞方法治疗不同类型肺结核咯血的疗效分析  

Two ways of bronchial artery embolization for various types of phthisic hemoptysis

作　　者：李景英 张守民 黄家勇 王秀军 

机构地区：[1]滨州市结核病防治院放射科,251700

出　　处：《国际医药卫生导报》2016年第4期460-463,共4页International Medicine and Health Guidance News

摘　　要：目的分析两种支气管动脉栓塞（BAE）方法与肺结核咯血类型及疗效之间的关系，探讨其最佳栓塞方法。方法收集2012年5月至2014年5月经支气管动脉栓塞治疗的50例继发性肺结核咯血患者，其中采用聚乙烯醇（PVA）颗粒加弹簧圈双重栓塞28例，PVA颗粒单独栓塞22例。双重栓塞和单独栓塞的咯血类型分别是慢性纤维空洞性15例和12例，浸润性13例和10例；复治性21例和14例，初治性7例和8例；单肺多支责任血管性（≥2支）18例和14例，单肺单支责任血管性lO例和8例。全部随访1—3年。分析两种栓塞方法之间、栓塞方法和咯血类型之间与疗效的关系。结果即刻止血50例，即刻止血率100．0％（50／50），总有效率（治愈＋有效）78．0％（39／50），复发率22．0％（11／50）。其中PVA颗粒加弹簧圈双重栓塞总有效率92．9％（26／28），PVA颗粒单独栓塞59．1％（13／22）。双重栓塞与单独栓塞之间疗效差异具有统计学意义f92．9％VS．59．1％，P〈0．05）。双重栓塞治疗慢性纤维空洞性、复治性、单肺多支责任血管性咯血疗效明显优于单独栓塞（P〈0．05），与浸润性、初治性、单肺单支责任血管性咯血之间疗效差异无统计学意义（P〉0．05）。结论BAE治疗肺结核咯血具有快捷有效、微创安全、适应证广等优点，已广泛应用于临床。根据咯血类型合理选择栓塞材料和栓塞方法，能进一步提高疗效。Objective To analyze the relationship of two ways of bronchial artery embolization （BAE） with their effect on different types of phthisic hemoptysis and to study the corresponding optimal way of embolization. Methods 50 patients with secondary phthisic hemoptysis treated by BAE from May, 2012 to May, 2014 were selected. Among them, 28 were treated by the combined embolization of polyvinyl alcohol （PVA） particles and coils and 22 only used PVA particles. 15 and 12 cases of chronic fihro-cavitative type, 13 and 10 cases of invasive type, 21 and 14 cases of recurrent type, 7 and 8 cases of initially-treated type, 18 and 14 cases of single lung multiple bronchi（〉2 bronchi） offending vessel-related type, and l0 and 8 cases of single lung single bronchus offending vessel-related type were treated by combined embolization or single embolization, respectively. All patients were followed up for i to 3 years. The relationship of two different ways of embolization and hemoptysis types with curative effect was investigated. Results 50 patients achieved prompt hemostasis, accounted for 100.0% （50/50）. The overall efficacy （cured ＋ effective） was 78.0% （39/50）. The recurrence rate was 22.0% （11/50）. The overall efficacies for combined embolization of PVA particles and coils and single embolization of PVA alone were 92.9% （26/28） and 59.1% （13/22）, respectively. There was a statistical difference in effectiveness between combined and single embolization （P〈0.05）. Combined embolization had significantly better curative effect （P〈0.05） than single embolization in the treatment of chronic fibro-cavitative, recurrent, and single lung multiple bronchi offending vessel-related hemoptysis. However, in regard to invasive, initially-treated, and single lung single bronchus offending vessel-related hemoptysis, there were no statistical differences between combined and single embolization （P〈0.05）. Conclusions BAE is a rapid, effective, minimally invasive, and safe way in the treat

关 键 词：肺结核 咯血 支气管动脉 栓塞方法 

分 类 号：R441.7[医药卫生—诊断学]