支气管动脉栓塞术治疗肺良性病变大咯血效果及预后  

Effect and prognosis of bronchial artery embolization in treatment of massive hemoptysis with benign pulmonary disease

作　　者：管恒星 徐鹏程 黄虎 董振楠 周卫忠[2] GUAN Hengxing;XU Pengcheng;HUANG Hu;DONG Zhennan;ZHOU Weizhong(Department of Interventional Radiology,the Affiliated Suqian First People’s Hospital of Nanjing Medical University,Suqian,Jiangsu 223800,China;Department of Interventional Radiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China)

机构地区：[1]南京医科大学附属宿迁第一人民医院介入放射科,江苏宿迁223800 [2]南京医科大学第一附属医院介入放射科,江苏南京210029

出　　处：《临床肺科杂志》2023年第12期1851-1856,共6页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨支气管动脉栓塞术(BAE)治疗肺内良性疾病大咯血疗效,分析复发因素。方法回顾性分析南京医科大学附属宿迁第一人民医院2016年9月-2019年9月收治的55例肺良性病变经支气管动脉栓塞术治疗大咯血患者资料,Log-rank单因素、Cox多因素分析影响咯血复发因素。Kaplan-Meier法计算介入术后止血率。结果55例患者均成功介入栓塞。术后胸部疼痛9例,发热6例,腹痛1例,给予对症处理均好转,无脊髓损伤等严重并发症。术后1月、6月、1年、2年、3年累积止血率分别为96.4%、94.5%、89.1%、72.7%、69.1%。无咯血平均生存时间30.1(28.33~33.49)月。单因素分析非支气管性体动脉(NBSA)、体肺循环分流(SPS)、肺毁损及栓塞材料与咯血介入术后复发相关(P<0.05)。多因素分析NBSA、栓塞材料为影响咯血介入栓塞术后复发的独立影响因素。结论支气管动脉栓塞术控制肺良性病变大咯血安全有效,随着术后时间延长累积复发率逐渐升高,栓塞材料、NBSA供血为术后复发独立影响因素。因此应重视NBSA供血栓塞,选用PVA等永久栓塞剂。Objective To explore the efficacy of bronchial artery embolization in treatment of benign lung lesions with massive hemoptysis and analyze the recurrence factors.Methods The clinical data of 55 patients with benign pulmonary disease treated with massive hemoptysis by bronchial artery embolization from September 2016 to September 2019 in Suqian First People′s Hospital Affiliated with Nanjing Medical University were retrospectively analyzed.Log-rank univariate and Cox multivariate analyses were performed to analyze the factors influencing the recurrence of hemoptysis.The hemostasis rate was calculated by the Kaplan-Meier method.Results All 55 patients were successfully embolized.9 patients had chest pain,6 patients had fever,and 1 suffered abdominal pain after the operation.These complications improved after symptomatic treatment,and no serious procedure-related complications such as spinal cord injury occurred after the operation.The cumulative hemostasis rates for 1 month,6 months,1 year,2 years,and 3 years were 96.4%,94.5%,89.1%,72.7%,69.1%respectively.The mean survival time of no hemoptysis patients was 30.1(28.33~33.49)months.Univariate analysis showed that non-bronchial body artery(NBSA),body pulmonary circulation shunt(SPS),pulmonary destruction,and embolization materials were associated with recurrence after hemoptysis intervention(P<0.05).Multivariate regression analysis revealed that NBS and embolization materials were the independent factors influencing the recurrence after interventional embolization of hemoptysis.Conclusion BAE is safe and effective for the control of massive hemoptysis with benign pulmonary disease.The cumulative recurrence rate gradually increases with the extension of postoperative time.Embolization materials and NBSA blood supply are independent influencing factors for postoperative recurrence.Therefore,NBSA blood supply embolization should be emphasized and permanent embolization agents such as PVA should be selected.

关 键 词：支气管动脉栓塞 咯血 复发 

分 类 号：R563[医药卫生—呼吸系统]