肺结核大咯血多次栓塞治疗的远期疗效及安全性观察

Repeated Bronchial Artery Embolization for Massive Hemoptysis Due to Pulmonary Tuberculosis:The Long Term Therapeutic Effect and Safety

目的评价支气管动脉栓塞治疗肺结核大咯血的疗效、并发症及安全性。资料与方法回顾分析64例肺结核伴大咯血患者支气管动脉重复多次栓塞治疗资料，方法为用明胶海绵颗粒栓塞后10～15min重复造影检查，再次循环栓塞前面的支气管动脉，直至血管完全闭塞后方结束治疗，并用同样的方法处理非支气管动脉来源的吻合支；另取15例肺结核伴大咯血患者行支气管动脉单次栓塞治疗15例作为对比组。结果单次栓塞组与多次栓塞组即刻止血有效率均为100％；多次栓塞治疗组近期总有效率95．3％，远期有效率60．9％，复发率39．1％；单次栓塞治疗组近期总有效率80％，远期有效率27％，复发率73％。两组之间近期有效率差异无统计学意义（P〉0．05），远期有效率差异有统计学意义（P〈0．05）。所有患者无严重并发症。结论明胶海绵支气管动脉栓塞治疗肺结核大咯血安全、有效、远期疗效明显；反复多次对同一支出血动脉进行栓塞效果好于仅行一次栓塞；首次栓塞15min后应再次少量栓塞以加强效果。

Objective To evaluate the therapeutic effect, complication and the safety of bronchial artery embolization （BAE） with gelatin sponge for massive hemoptysis caused by pulmonary tuberculosis. Materials and Methods 64 cases of pulmonary tuberculosis with massive hemoptysis （Group A） were retrospectively analyzed. The digital subtracted bronchial arteriogram was perfomed and bleeding arteries were embolized repetitively. 10 - 15 minutes later, the bronchial artery was repeated embolization utntil it was obturated complately. The same method was applied to obturate other non-bronchial ramus anastomoticus. Other 15 cases as control （Group B） were embolized only once. Results Immediately after embolization, bleeding stopped in 100% in both group A and B. In group A, the short-term efficiency, the long-term efficiency and recurence rate were 95.3%, 60.9% and 39.1% respectiyely. In group B, the short-term efficiency, the long-term efficiency and recurence rate were 80% , 27% and 73% respectively. There was no significant difference between two groups in the short-term efficiency （ P 〉 0.05 ）, but has significant difference in the long-term efficiency （ P 〈 0.05 ）. No serious complications occurred in all cases. Conclusion Bronchial artery embolization is a safe and efficient method for control massive hemoptysis due to pulmonary tuberculosis. Repeated bronchial artery embolization is better than only once embolization. The second embolization shouldbe performed after the first embolization for 15 minutes.