应用明胶海绵和聚乙烯醇颗粒动脉栓塞治疗肺咯血疗效及复发原因分析

Effect of Treatment and Analysis of Recurrence of Artery Embolization by Using Gelfoam and Ivalon to Control Pulmonary Hemoptysis

目的探讨应用明胶海绵(GS)和聚乙烯醇(PVA)颗粒动脉栓塞术治疗肺咯血治疗效果及复发原因分析。材料和方法对85例肺咯血患者(单纯性支气管扩张21例、肺结核及结核性支扩48例、肺癌6例、肺曲菌病3例、矽肺2例、肺脓肿1例、肺囊肿1例、原因不明3例)行动脉栓塞术止血。栓塞剂分别采用GS、PVA颗粒,其中单纯应用GS25例,单纯应用PVA颗粒32例,联合应用GS、PVA颗粒28例。全部病例随访6个月以上。结果即时止血72例(84.7%),一次性治愈44例(51.8%),显效和好转37例(43.5%),无效4例(4.7%)。25例复发(29.4%),肺结核及结核性支扩占20例,二次栓塞9例,治愈5例。一次性治愈44例中单纯性支气管扩张17例,肺结核及结核性支扩17例,肺癌2例(即时止血率100%,另外4例晚期肺癌因其他原因在6月内死亡),肺曲菌病2例,肺脓肿1例,矽肺2例,肺囊肿1例,原因不明2例;单纯应用GS治愈8例(治愈率32%),单纯应用PVA颗粒治愈18例(治愈率56.3%),联合应用GS、PVA颗粒治愈18例(治愈率64.3%)。结论动脉栓塞术治疗肺咯血疗效显著。单纯应用GS治愈率<单纯应用PVA颗粒治愈率<联合应用GS、PVA颗粒治愈率。肺结核及结核性支扩疗效相对较差,复发率相对较高。

Purpose:To analyze the effect of treatment and the cause of recurrence of artery embolization by using gelfoam and ivalon to control pulmonary hemoptysis.Materials and Methods:Artery embolization was performed on85patients including pure bronchiectasis(n=21),tuberculosis and tuberculous bronchiecˉtasis(n=48),pulmonary carcinoma(n=6),aspergillosis(n=3),silicosis(n=3),lung abscess(n=1),lung cysts(n=1),unknown hemoptysis(n=3).The hemostatic agents included Gelfoam(GS)and Ivalˉon.25cases were embolized with GS,32cases were embolized with PVA,28cases were embolized with GS and PVA.All patients were followed over six months.Results:Immediate cessation of hemoptysis(n=72,84.7%),once cure without recurrence(n=44,51.8%),having significant effect(n=37,43.5%),invalid(n=4,4.7%).25cases recured massive bleeding(29.4%),in which20cases had tuˉberculosis and tuberculous bronchiectasis.9cases were embolized again and5cases were cured.Among cases of once cure without recurrence:pure bronchiectasis(n=17),tuberculosis and tuberculous bronchiectasis(n=17),pulmonary carcinoma(n=2),aspergillosis(n=2),silicosis(n=2),lung abscess(n=1),lung cysts(n=1),unknown hemoptysis(n=2).Cured cases and rate of artery embolization by GS,PVA,GS+PVA were8(32%),18(56.3%),18(64.3%).Conclusion:The effect of artery embolization to control pulmonary hemoptysis is evident.Cured cases and rate:GS<PVA<GS+PVA.The effect on paˉtients with tuberculosis and tuberculous bronchiectasis is less evident,and they are prone to recurring.