选择性动脉栓塞术治疗咯血效果及复发相关因素分析  

Selective arterial embolization for hemoptysis:clinical analysis of the curative effect and recurrent factors

作　　者：张文浩[1] 叶丽芳[1] 任医民[1] 赖清[1] 伍筱梅[1] ZHANG Wenhao;YE Lifang;REN Yimin;LAI Qing;WU Xiaomei(Department of Radiology,First Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong Province 510210,China)

机构地区：[1]广州医科大学附属第一医院放射科,510210

出　　处：《介入放射学杂志》2020年第1期35-38,共4页Journal of Interventional Radiology

摘　　要：目的评价选择性动脉栓塞术(SAE)治疗咯血的效果,分析影响术后复发的因素。方法回顾性分析2010年1月至2017年4月收治的符合入组标准的600例咯血患者临床资料。对一般资料、病变动脉数、动脉造影表现、随访结果进行统计学分析。一般资料采用描述性统计和频数分析。以病变动脉数3支为临界值,将全部入组患者分为A组(病变动脉数≤3,n=231)和B组(病变动脉数>3,n=369),t检验分析两组资料间差异。生存分析寿命表法分析手术止血率。Cox回归模型分析复发影响因素。结果A、B组支气管动脉(BA)均数和非支气管性体动脉(NBSA)均数差异均有显著统计学意义(P<0.01)。病变动脉数>3支时,异常BA和NBSA数均增加,且NBSA数显著增加。SAE术后24 h、3个月、6个月、1年、2年、3年累积止血率分别为99%、81%、78%、72%、66%、63%。Cox回归模型分析显示,病变动脉数是术后咯血复发的独立影响因素。B组复发风险更高,为A组的1.742倍(95%CI=1.307~2.321,P<0.05),说明复发与NBSA供血相关。结论SAE治疗咯血有效。NBSA参与血供越多,不完全栓塞概率就越高,复发可能性就越大。重视术中发现NBSA并予栓塞,对提高咯血止血效果有重要意义。Objective to evaluate the curative effect of selective arterial embolization(SAE)in treating hemoptysis,and to analyze the factors influencing postoperative recurrence.Methods The clinical data of 600 hemoptysis patients in accordance with the inclusion criteria,who were admitted to authors’hospital and received SAE during the period from January 2010 to April 2017,were retrospectively analyzed.The general information,number of diseased arteries,angiographic findings and follow-up results were statistically analyzed.Descriptive statistics and frequency analysis were used for general data.Taking the diseased arteries of 3 as the critical value,the patients were divided into group A(number of diseased arteries≤3,n=231)and group B(number of diseased arteries>3,n=369).The differences in data between the two groups were analyzed by t test.The operative hemostatic rate was analyzed by survival analysis lifespan table method.Cox regression model was used to analyze the factors influencing the recurrence.Results Statistically significant differences in the mean number of both bronchial artery(BA)and non-bronchial systemic artery(NBSA)existed between group A and group B(P<0.01).When the number of diseased arteries was larger than 3,the number of both abnormal BA and NBSA were increased,and the increase in the number of NBSA was more significant.The 24-h,3-month,6-month,one-year,2-year and 3-year post-SAE cumulative hemostasis rates were 99%,81%,78%,72%,66%and 63%,respectively.Cox regression model analysis showed that the number of diseased arteries was the independent factor influencing the recurrence.The risk of recurrence in group B was much higher than that in group A,which was 1.742 times as much as group A(95%CI:1.307-2.321,P<0.05),indicating that the recurrence of hemoptysis was related to the blood supply from NBSA.Conclusion SAE is an effective treatment for hemoptysis.The more the NBSA participates in the blood supply,the higher the probability of incomplete embolization as well as the greater the likelihood

关 键 词：咯血 选择性动脉栓塞术 疗效 复发因素 

分 类 号：R563.5[医药卫生—呼吸系统]