支气管动脉栓塞治疗急性大咯血疗效分析

Analysis of bronchial arterial embolization for acute massive hemoptysis

目的:总结支气管动脉栓塞治疗大咯血的临床经验。方法:对介入治疗的42例大咯血患者进行回顾性分析。结果:34例平片或CT提示病变部位与出血动脉分布区相符。DSA造影发现病变支气管动脉63支,起自左主支气管影内或接近左主支气管影58支。造影见支气管动脉增粗、走行迂曲等,栓塞后再次造影见末梢血管闭塞,仅有主干近端显影。栓塞后咯血立即停止36例,咯血量明显减少4例,咯血未改善1例,一过性头颈部胀感、胸痛及全身不适28例,未出现脊髓损伤等严重并发症。3个月、6个月、12个月咯血累积复发分别为4例、8例、12例。结论:术前胸部平片和(或)CT扫描有助于提示出血部位,术中DSA图象显示的左主支气管影是寻找支气管动脉开口的可靠参考指标。经导管栓塞治疗大咯血近期疗效显著,部分病例可达到根治效果,但长期控制出血需要进一步探讨。

Objective To summarize the experiences of acute massive hemoptysis treated by bronchial arterial embolization(BAE). Method 42 cases affected hemoptysis treated were retrospectively reviewed. Result The sites of those lesions from chest radiography or CT scan in 34 cases were consistent with the dimension of bleeding artery in angiography. DSA showed 63 bronchial arteries contributing to bleeding, 58 of which were within or near the shadow of the left main bronchus. Bronchial artery hypertrophy and tortuosity were found. After embolization, peripherical vascular was occluded and remmant trunk was detected in repeated angiography. BAE resulted in an immediate cessation of hemoptysis in 36 cases, reduction notably in 4 and no improvement in 1. There were head-neck swelling, pectoralgia, and malaise in 28, but no severe complications like neurological deficiency were observed. The cumulative relapse of hemoptysis was 4, 8 and 12 cases at interval of 3, 6 and 12 months. Conclusion Preoperative chest radiography and/or CT scan is helpful in localising the lesions. The shadow of the left main bronchus from DSA is a reliable reference in seaching for the origin of the bronchial artery. BAE for massive hemoptysis showes significant short-term efficacy and curable efficacy in some cases, but it is needed to study further for long-term efficacy.