支气管动脉栓塞联合肺叶切除治疗咯血分析  

Analysis of bronchial artery embolization combined with lobectomy for treatment of hemoptysis

作　　者：游佩涛[1] 刘建雄[1] 薛宗锡[1] 卢小红[1] 邵琤 陈晓辉 陈卓宏[1] 刘文[1] YOU Pei-tao;LIU Jian-xiong;XUE Zhong-xi;LU Xiao-hong;SHAO Cheng;CHEN Xiao-hui;CHEN Zuo-hong;LIU Wen(Department of Thoracic Surgery,Guangzhou Chest Hospital,Guangdong 510095,China)

机构地区：[1]广州市胸科医院胸外科

出　　处：《影像诊断与介入放射学》2019年第3期209-213,共5页Diagnostic Imaging & Interventional Radiology

摘　　要：目的比较咯血患者支气管动脉栓塞联合肺叶切除的治疗模式与常规肺叶切除术的手术安全性和术后并发症。方法回顾我院2013年~2018年85例因咯血内科治疗无效,肺部器质性改变明显,需行肺叶切除术的病例资料。37例行支气管动脉栓塞术,再择期全麻下胸腔镜加小切口行肺叶切除术;另48例患者仅于全麻下胸腔镜加小切口行肺叶切除术。比较支气管动脉栓塞术加肺叶切除术联合治疗和单纯性肺叶切除术,统计手术操作时间、术中出血、术后3d胸腔引流管渗液量和术后出院时间的差别。结果本组数据显示,在单一肺叶切除术中,术前行支气管动脉栓塞术的联合治疗组手术时间和术后3d胸腔渗液分别为(5.14±1.21)h和(855.00±481.18)ml,未行支气管动脉栓塞术的单一肺叶切除组分别为(6.24±1.94)h和(1172.65±558.63)ml,差异有统计学意义(P<0.05),而术中出血和术后住院天数,两组无统计学差异(P>0.05);在复合肺叶切除术中,联合治疗组手术时间、术中出血、术后3d胸腔渗液和术后住院天数分别为(6.00±1.25)h、(459.33±318.26)ml、(970.67±293.61)ml和(14.87±4.96)d,对照组分别为(7.29±1.73)h、(862.14±630.22)ml、(1332.86±212.22)ml和(22.14±11.65)d,差异均有统计学意义。结论咯血患者肺叶切除前行支气管动脉栓塞术,在手术安全性和并发症控制上优于常规肺叶切除术,在复杂肺叶切除术中的作用更加明显。Objective To compare treatment of hemoptysis by combined bronchial artery embolization and lobectomy with conventional lobectomy alone. Methods 85 patients with lung parenchymal changes and ineffective medical treatment of hemoptysis from 2013 to 2018 underwent lobectomy (48) or bronchial artery embolization followed by lobectomy (37).The operation time,intra-operative bleeding,post-operative pleural effusion,and postoperative hospital stay were compared between the two groups.Results In simple lobectomy,the operation time (5.14±1.21 h) and volume of post-operative pleural effusion within 3 days (855.00±481.18 ml) in the combined treatment group were significantly lower than that of lobectomy alone (6.24±1.94 h,1172.65±558.63 ml).There was no statistical difference in intra-operative bleeding and post-operative hospital stay.In compound lobectomy,the operation time (6.00±1.25 h),intraoperative bleeding (459.33 +318.26 ml),pleural effusion (970.67±293.61 ml) and hospital stay (14.87±4.96 d) for the combined treatment group were significantly lower than that of lobectomy alone (7.29±1.73 h,862.14±630.22 ml,1332.86±212.22 ml,22.14±11.65 d).Conclusion Bronchial artery embolization before lobectomy is superior to conventional lobectomy in surgical safety and complication control of hemoptysis.

关 键 词：咯血 栓塞 肺叶切除术 介入治疗 

分 类 号：R655[医药卫生—外科学]