支气管动脉-肺循环瘘并顽固性咯血的介入治疗方法比较

Interventional therapy of refractory hemoptysis complicated with bronchial artery to pulmonary circulation shunt

目的改进介入治疗方法以达到对支气管-肺循环瘘(BPS)相关的顽固性咯血更好的治疗效果。方法收集我院1996年9月-2010年2月DSA血管造影证实具有支气管-肺循环瘘致咯血病例99例,所有患者均行介入栓塞治疗,分为传统单纯明胶海绵栓塞法组和永久栓塞组。所有患者在术后1d,2、4周,6个月,1、2年均有随访,数据用方差分析、秩和检验进行分析。结果栓塞术后1d,2、4周,6个月,1、2年随访示52例永久栓塞组中治愈41例,显效9例,有效2例。47例单纯明胶海绵组中治愈21例,显效18例,有效5例,无效3例。两组经秩和检验P<0.05,差异有统计学意义。结论本研究表明:①选择性支气管动脉永久双重栓塞治疗是BPS引起的顽固性咯血的有效治疗方法。②对BPS患者,小颗粒栓塞效果明显,并发症少。

Objective The presence of bronchial artery to pulmonary circulation shunt（BPS） is the pathologic reason for refractory hemoptysis.Those who have accepted traditional bronchial arterial embolization（BAE） treatment usually carry high risks of recurrence of hemoptysis.At the same time,because of the limits of BAE treatment,safety can not be ignored when we pay full attention to its therapeutic effect.This research aims to find out an effective method to treat the refractory hemoptysis with BPS.Methods During the period from Sep.1996 to Feb.2010,two hundred and twelve patients of hemoptysis were treated with BAE.Of the total 212 patients,BPS was confirmed by DSA angiography in 99,including 72 males and 27 females with a mean age of 47.6 years.The primary diseases included bronchiectasis（n = 25）,tuberculosis（n = 64） and inflammatory disorders（n = 10）.All patients were treated with BAE.According to the embolization agent used in the treatment the patients were divided into pure Gelfoam group（n = 52） and permanent embolization group（n = 47,using PVA particles,coils,etc.）.All patients were followed up regularly at one day,two weeks,four weeks,six months,one year,two years after the treatment.The data were analyzed by using chi square test and rank sum test.Results Of 52 cases in permanent embolization group,complete cure was achieved in 49,excellent results in 2 and effective response in one.For patients in pure Gelfoam group,complete cure was obtained in 37,excellent results in 16,effective response in 2 and ineffectiveness in 2.Statistic analysis showed that a significant difference in therapeutic effectiveness existed between two groups（P 0.05）.Conclusion This study clearly indicates that selective bronchial arterial permanent dual embolization is an effective technique for the treatment of refractory hemoptysis,which is definitely superior to the pure Gelfoam emboliztion in obtaining excellent therapeutic results.Besides,for patients with bronchial artery to pulmonary artery shunt bronchial arterial embolization with fine particles is more effective and has fewer complications.