TAGM联合微弹簧圈栓塞治疗支气管扩张所致大咯血的疗效及安全性  

Efficacy and safety of TAGM combined with microcoil embolization for massive hemoptysis caused by bronchiectasis

作　　者：薛文强 卫丹[2] 冯敬东[2] 杜晶磊 于世平[2] XUE Wenqiang;WEI Dan;FENG Jingdong;DU Jinglei;YU Shiping(Shanxi Medical University,Taiyuan 030001,China;Department of Interventional Therapy,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学,山西太原030001 [2]山西医科大学第二医院介入治疗科,山西太原030001

出　　处：《实用放射学杂志》2023年第12期2030-2033,共4页Journal of Practical Radiology

摘　　要：目的探讨三丙烯酸酯明胶微球(TAGM)联合带纤维铂金弹簧圈(微弹簧圈)行支气管动脉栓塞(BAE)治疗支气管扩张所致急性重症大咯血的疗效及安全性。方法回顾性分析48例患者,造影明确病变血管后,先使用TAGM(300~500μm)栓塞远端毛细血管床,依据病变小动脉直径选择微弹簧圈栓塞中段血流后再次使用TAGM(500~700μm)栓塞近端血管;合并肺动/静脉瘘患者,依据瘘口大小及血流速度选择合适的TAGM(500~700μm)栓塞后再用多枚微弹簧圈致密栓塞;栓塞后造影明确病变血管完全闭塞。结果总体手术成功率为95.83%,36例患者即刻止血;6例有效;4例好转;1例无效,为责任血管漏栓所致,二次栓塞后好转;1例术中突发大咯血呛咳窒息,抢救无效死亡。随访3~51个月,1例突发大咯血死亡;4例因感染控制不佳、侧支循环形成再发咯血,再次栓塞后控制;1例支气管扩张合并肺结核,双肺病灶多发、肺部感染严重引起反复咯血,共行4次栓塞。所有复发咯血患者造影均未见原栓塞血管再通,随访期间患者总生存率为97.87%,咯血控制率为87.23%。结论TAGM联合微弹簧圈对急重症大咯血责任动脉分级栓塞安全、有效,近期效果和远期预后良好。Objective To study the efficacy and safety of bronchial artery embolization(BAE)with tris-acryl gelatin microspheres(TAGM)combined with platinum spring coil with fiber(microcoils)in the treatment of acute severe hemoptysis caused by bronchiectasis.Methods A retrospective analysis of 48 patients with bronchiectasis was performed.After the lesion vessels were confirmed by angiography,the distal capillary bed was embolized with TAGM(300-500μm),the middle blood flow was embolized with microcoils according to the diameter of the small artery,and then the proximal vessels were embolized with TAGM(500-700μm)again.In patients with pulmonary artery/vein fistula,appropriate TAGM(500-700μm)was selected according to the size of the fistula and the blood flow velocity,followed by dense embolization with multiple microcoils.The complete occlusion of the lesion vessel was confirmed again by arteriography after embolization.Results The overall success rate of operation was 95.83%.There were 36 patients with immediately stopped bleeding,6 cases with effective treatment,4 cases with improved treatment,1 case with invalid treatment due to the leakage of the responsible blood vessel,which was improved after the second embolization.There was 1 case died in surgery due to sudden massive hemoptysis,choking and suffocation.During the 3-51 months follow-up,1 patient died due to sudden massive hemoptysis;4 patients had recurrent hemoptysis due to poor control of infection and collateral circulation,which were controlled after reembolization,and 1 patient with bronchiectasis and pulmonary tuberculosis had repeated hemoptysis caused by multiple pulmonary lesions and severe pulmonary infection,performing on four times embolization.There was no patient with recurrent hemoptysis occurring recanalization of primary embolized vessel.During the follow-up,the overall survival rate was 97.87%,and the hemoptysis control rate was 87.23%.Conclusion TAGM combined with microcoils is safe and effective in the treatment of acute massive hemoptysis,whic

关 键 词：支气管扩张 急性大咯血 栓塞材料 疗效 

分 类 号：R562.22[医药卫生—呼吸系统] R441.7[医药卫生—内科学] R815[医药卫生—临床医学]