支气管动脉破裂咯血的介入治疗

Interventional therapy of hemoptysis due to rupture of bronchial artery

目的探讨支气管动脉发生变异、动脉硬化严重及多发病变患者插管技术、栓塞剂的选择及其临床价值。方法30例支气管动脉介入治疗的患者,其中肺癌并支气管动脉破裂出血9例,支气管扩张咯血21例,均采用Seldinger穿刺技术,选用6F或5F型号的Cobra导管、Magic、SP微导管,超选择性插管造影,用明胶海绵颗粒(约<0.5mm3)+超液化碘油;聚乙烯醇微球(PVA:500～700μm)栓塞剂栓塞治疗,其中1例采用血管内磨损伤血栓形成方法。结果其中,26例一次造影及超选择栓塞成功,术后咯血停止;另4例因血供复杂,第一次栓塞后1个月复发,行二次栓塞成功,咯血停止。结论在高龄并动脉硬化及变异支气管动脉的插管栓塞术中,应采用微导管技术,行超选择性插管准确到位,既可用明胶海棉+超液化碘油,又可用PVA颗粒等永久栓塞剂使栓塞能安全可靠,并能达到长期疗效。

Objective To study the catheterization technique,selection of embolizing agent and their clinical value in the hemoptysis patients with bronchial artery variation, severe arteriosclerosis and multiple lesions.Methods The 30 patients with hemoptysis due to bronchogennesis were included in this study among whom 9 cases had lung cancer and 21 had bronchiectasis. Seldinger technique, 6F or 5F Cobra catheter, Magic, SP microcatheter and super-selective catheterization, Gelfoam particles（〈 0.5mm^3）＋hyperliquified iodized oil,as well PVA microsphere （500-700μ） were used as the embolizing agents in above-mentioned patients, Intravascular trauma induced thrombosis was successfully employed in Ⅰ case. Results Angiography and superselective embolization were successful in one single session in 26 of 30 cases,hemoptysis ceased following the procedure. In the remaining 4 cases,recurrence due to the complex blood supply, occurred 1 month after the first embolization, however, hemoptysis was successfully controlled following second embolization. Conclusion In this study microcatheter and super-selective catheterization were recommended in the treatment of hemoptysis in those patients that all elderly, with severe arteriosclerosis or variant bronchial artery.The results show that either gelboam ＋ hyperliquified iodized oil or permanent embolizing agent such as PVA particles may be safe in use and has reliable long-term treatment results.