支气管扩张大咯血DSA特点及栓塞治疗

DSA findings and bronchial arterial embolization of bronchiectasis with massive hemoptysis

目的探讨支气管扩张(支扩)大咯血病变动脉DSA表现特点及栓塞治疗疗效。方法35例支扩大咯血患者,参考胸片、CT等影像资料行选择性支气管动脉及其他目标血管DSA检查,根据造影表现行病变动脉栓塞治疗,栓塞材料为PVA和(或)明胶海绵颗粒(条),术后随访疗效。结果①DSA表现:病变血管单独为支气管动脉占74.3%,合并非支气管体循环动脉22.9%,单独为非支气管动脉2.9%,异常动脉数量为1～5(平均1.8)支/例。显示出血直接征象25.7%,间接征象100%。②栓塞情况及疗效:栓塞34例共61支病变血管;应用微导管16例。1例3d内栓塞2次无效,3个月内复发4例,3个月后复发2例,栓塞治疗总有效率为85.3%,复发率为20.6%,无脊髓损伤等严重并发症。结论支扩大咯血DSA检查阳性率高,参考造影特点行选择性病变动脉栓塞治疗安全性好,疗效确切。

Objective To explore DSA findings curative measures and effects of bronchial arterial embolization （BAE）of bronchiectasis with massive hemoptysis. Methods 35 patients with massive hemoptysis due to bronchiectasis were performed selective bronchial arterial DSA and BAE referring to image data of chest plain film and CT, Embolic materials were polyvinyl alcohol （PVA）and/or gelatinum sponge particles. Curative effects were followed-up for 3 months to 3 years. Results ①DSA revealed bronchial artery as being the only abnormal vessel accounted for 74.3%, bronchial artry combined with nonbronchial systemic artery as 22.9% and only non-bronchial artery involved 2.9%. Abnormal vessel number was 1 - 5 （mean 1.8） per case. Direct and indirect bleeding sign was displayed as 25.7% and 100% respectively. ②Curative and embolization effects were shown as 61 target vessels of 34 patients being embolized and total effective rate reaching 85.3% ; of which 16 cases were adopted super-selective technique, 1 case was failure of stopping bleeding for two times within 3 days, 4 cases recurred within 3 months and 2 cases recurred over 3 months; with recurrent rate of 20.6%, but no serious complications such as spinal cord injury. Conclusions DSA examination and selective BAE of bronchiectasis with massive hemoptysis could provide high positive angiographic features and reliable curative effect.