肺结核大咯血支气管动脉栓塞后短期复发原因分析

Causes analysis of short-term recurrence after bronchial artery embolization in hemoptysis

目的:探讨经导管支气管动脉栓塞(BAE)治疗肺结核大咯血术后短期复发的原因及其预防措施。方法:对237例肺结核伴大咯血行BAE术后1个月内复发的24例患者进行回顾性分析,并探讨其复发原因,结果:237例大咯血患者中24例BAE术后短期复发;复发的原因包括非支气管动脉供血(9例)、支气管动脉再通(7例)、病变血管漏栓(3例)、原发病进展(5例)。有支气管动脉肺静脉瘘或(和)支气管动脉肺动脉瘘患者复发率较高,出血量与复发原因无显著性差异。结论:病灶供血血管难以彻底处理及因技术原因而造成的漏栓是短期复发的主要原因,寻找多支支气管动脉及参与供血的非支气管动脉并予以多次栓塞是预防大咯血短期复发的主要措施。

Objective： To investigate the causes and precautions of short-term recurrence after bronchial artery embolization（BAE） in hemoptysis. Methods： 237 cases of pulmonary tuberculosis with massive hemoptysis were retrospectively analyzed, and the causes which symptoms recur within 1 month were investigated. Results： There were 24 recurrence cases in total 237 cases. Among them, 9 cases were nonbronchial arteries supply ,and recanalization 7 cases, omission 3 cases, primary disease advancement 5 cases, respectively. The recurrence rate was higher in arteria trachealis- pulmonary vein/artery shunt ,and there was no significant difference in volume of haemorrhagia. Conclusion： The difficulty of supply arteries management and arterial embolism technique are the main short-term recurrence reasons in massive hemoptysis. Searching for nonbronchial supply arteries and repetitive embolization with BAE are the main precaution measures.