咯血患者经血管内栓塞治疗的临床研究  

Clinical study on endovascular embolization in patients with hemoptysis

作　　者：应祥宇 赵超云 仝雪霞 李芳[3] YING Xiangyu;ZHAO Chaoyun;TONG Xuexia;LI Fang(Ningxia Medical University,Yinchuan 750004,China;Department of Interventional Radiology,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Respiratory and Critical Care Medicine,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学,宁夏银川750004 [2]宁夏医科大学总医院放射介入科,宁夏银川750004 [3]宁夏医科大学总医院呼吸与危重症医学科,宁夏银川750004

出　　处：《宁夏医学杂志》2025年第3期248-252,共5页Ningxia Medical Journal

基　　金：宁夏留学回国人员创新创业项目(202305)。

摘　　要：目的探讨经血管内栓塞治疗咯血患者的咯血病因、诊断思路、栓塞治疗的效果。方法回顾性分析161例经血管内栓塞治疗的咯血患者的一般资料、临床表现、影像学检查、支气管镜检查、病因、术中血管造影情况、术后转归。161例咯血患者均行血管内栓塞治疗,其中134例(83.2%)进行支气管动脉栓塞术,5例(3.1%)进行非支气管性体动脉栓塞术,11例(6.8%)进行支气管动脉栓塞术和非支气管性体动脉栓塞术,8例(5.0%)进行支气管动脉栓塞术和支气管动静脉瘘栓塞术,3例(1.9%)进行肺动脉瘤栓塞术。结果161例患者咯血患者中,52例(32.3%)为小量咯血,36例(22.4%)为中量咯血,73例(45.3%)为大量咯血。161例患者均完成胸部CT检查,诊断阳性率为72.7%。155例患者完成支气管动脉CTA,诊断阳性率为79.4%。63例患者完成支气管镜检测,诊断阳性率为25.4%。136例患者明确了咯血病因,主要为肺结核(28.0%),其次是支气管扩张(20.5%)、肺部真菌感染(12.4%)。161例患者术中血管造影共找到286支病变血管,其中支气管动脉261支,非支气管性体动脉22支,肺动脉3支。术后短期疗效中,显效117例,有效28例,无效16例,治疗总有效率达到90.1%。结论本研究中咯血患者最常见的病因为肺结核、支气管扩张。血管内栓塞治疗术中造影发现咯血患者主要病变血管为支气管动脉,少数患者为非支气管性体动脉,以肋间动脉为主。Objective To explore the etiology of hemoptysis,diagnostic ideas,and the efficacy of embolization in patients with hemoptysis treated with endovascular embolization.Methods General data,clinical presentation,imaging,bronchoscopy,etiology,intraoperative angiography,and postoperative regression were retrospectively analyzed in 161 patients with hemoptysis treated with endovascular embolization.A total of 161 patients with hemoptysis were treated with endovascular embolization,of which 134 patients(83.2%)underwent bronchial artery embolization,5(3.1%)underwent non-bronchial body artery embolization,11(6.8%)underwent bronchial artery embolization and non-bronchial body artery embolization,8(5.0%)underwent bronchial artery embolization and bronchio-arteriovenous fistula embolization,and 3(1.9%)underwent embolization of pulmonary aneurysm.Results A total of 161 with hemoptysis,52(32.3%)had a small amount of hemoptysis,36(22.4%)had a moderate amount of hemoptysis,and 73(45.3%)had a large amount of hemoptysis.Chest CT was completed in 161 patients with a diagnostic positivity rate of 72.7%.155 completed bronchial artery CTA with a diagnostic positivity rate of 79.4%.63 completed bronchoscopic testing with a diagnostic positivity rate of 25.4%.The etiology of hemoptysis was clarified in 136 cases,mainly tuberculosis(28.0%),followed by bronchiectasis(20.5%),and fungal infections of the lungs(12.4%).A total of 286 diseased vessels were identified by intraoperative angiography in 161 cases,including 261 bronchial arteries,22 nonbronchial body arteries,and 3 pulmonary arteries.In short-term postoperative efficacy,117 cases showed significant effect,28 cases were effective,16 cases were ineffective,and the total effective rate of treatment was 90.1%.Conclusion The most common causes of hemoptysis in the patients in this study are tuberculosis and bronchiectasis.Intraoperative angiography of endovascular embolization therapy could reveal that the predominantly diseased vessels in patients with hemoptysis are bronchial arteries,

关 键 词：咯血 血管内栓塞治疗 短期疗效 

分 类 号：R651.12[医药卫生—外科学]