体-肺循环分流与大咯血(附62例报告)

elationship between broncho-pulmonary shunt and massive hemoptysis (A report of 62 cases)

目的探讨体-肺循环分流(BPS)与大咯血的相关性及其介入干预。方法1999年4月～2006年7月咯血患者62例。其中,男39例,女23例;年龄26～84岁。咯血量300～2500mL/24h。回顾相关支气管体动脉造影,观察其形态学和血流动力学改变。综合影像学和临床资料,分析BPS与大咯血的关系;原发病、胸膜增厚与BPS的关系;BPS与咯血复发的关系;以及BPS的介入治疗。所有数据经χ2分析处理。结果BPS与大咯血关系密切;BPS与支气管扩张、显著的胸膜增厚等相关;BPS是不明原因咯血的主要因素;栓塞优势供血动脉后,BPS可诱使非优势动脉甚至隐匿侧支开放。结论BPS是大咯血的重要因素,也是栓塞后复发咯血的重要原因。BPS常伴随于各种原因引起的支气管扩张和严重胸膜增厚。彻底栓塞BPS及其供血动脉是预防咯血复发的关键。

[Objection] To investigate the relationship between systemic- pulmonary circulation shunt and massive hemoptysis, and the correlative factors to shunts, to study the intervention of shunts. [Methods] 62 cases of Bronchial hemoptysis with varied bleeding volume from 300-2500 mL/24 hrs treated with superselective arterial embolizations during 1994.4-2006.7 （39 males, 23 females, aged from 26-84） were studied retrospectively. Morphologic and dynamic changes of the bronchial circulation in systemic bronchial angiography were observed. Relationships a- mong BPS, massive hemoptysis, the original chest diseases, pleural incrassation, and recurrent hemoptysis were analyzed. Interventional treatment to BPS was studied. All data were analyzed by χ^2 test. [Results] The very close relationship between BPS and massive hemoptysis was proven; BPS had relations to bronchiectasis and severe pleural incrassation; BPS would be the main reason to the unknown hemoptysis; BPS seduced the opening of the non- predominant branches after the predominance was being embolized. [Conclusion] BPS is a very important factor to massive hemoptysis and reocurrent hemoptysis. It commonly presents in bronchiectasis caused by different diseases and severe pleural incrassation. The key point for preventing recurrence is thoroughly embolizing BPS and its supplying branches.