选择性支气管动脉栓塞术控制匿源性咯血

Selective bronchial artery embolization for the treatment of cryptogenic hemoptysis

目的分析匿源性咯血患者支气管动脉造影的影像学表现,评估选择性支气管动脉栓塞术(BAE)治疗匿源性咯血的临床价值。方法 2004年6月至2011年3月对11例内科保守治疗无效的匿源性咯血患者行选择性BAE。术中行系统的主动脉造影及锁骨下动脉造影,观察责任血管的影像学表现及来源,并对双侧支气管动脉(BA)及非支气管性体动脉(NBSA)责任血管行选择性栓塞术。术后随访6个月～5年。结果 11例患者中10例为吸烟者(或有吸烟史)。所有患者术前CT增强检查及纤维支气管镜检查均未发现肺实质内与咯血有关的实质性病变。11例患者中,10例术中动脉造影存在血管异常表现,总共24支责任血管,其中右侧支气管动脉11支、左侧支气管动脉8支、胸廓内动脉2支、肋间动脉3支。术后8例咯血立即停止,2例仍有少量咯血经保守治疗后好转,1例术后仍有咯血,行肺叶切除术后好转。术后2例出现不同程度胸痛,1例出现发热,1例出现轻度肾功能不全,均经处理后缓解,所有患者均未出现其他严重的栓塞后并发症。所有患者术后1个月内无再次咯血,1例术后5个月咯血复发,经保守治疗后好转。结论吸烟是匿源性咯血的一大危险因素,BA是匿源性大咯血的主要责任血管;选择性BAE治疗匿源性大咯血安全、有效,是首选的一线治疗手段,

Objective To analyze the bronchial artery angiographic findings of cryptogenic hemoptysis and to assess the clinical value of selective bronchial artery embolization（BAE） in treating cryptogenic hemoptysis.Methods During the period from June 2004 to March 2011,selective bronchial artery embolization（BAE） was adopted in 11 patients with uncontrollable cryptogenic hemoptysis.Systemic aortic angiography and subclavian artery angiography were performed during BAE procedure to confirm the feeder vessel and its origin.The bronchial arteries（BA） and non-bronchial systemic arteries（NBSA） that were responsible for hemoptysis were embolized with PVA particles（350-750 μm）.The clinical results and complications were documented.All the patients were followed up for 6 months to 5 years.Results Ten of the 11 patients（10 males and one female） were smokers.No pulmonary parenchymal lesions were detected by preoperative enhanced computed tomography and by fiberoptic bronchoscope.Angiography showed that vascular abnormality was seen in 10 of the 11 patients,and a total of 24 responsible feeder vessels were verified,including right bronchial artery（n = 11）,left bronchial artery（n = 8）,internal mammary artery（n = 2） and intercostal artery（n = 3）.In 8 patients the hemoptysis ceased immediately after BAE.In two patients a small amount of hemoptysis remained,which was improved after conservative treatment.One patient still had active hemoptysis after BAE and pulmonary lobectomy had to be carried out.Postoperative complications included different degrees of chest pain（n = 2）,fever（n = 1） and mild renal insufficiency（n = 1）,which were relieved after clinical management.No serious post-embolization complications occurred.No recurrence of hemoptysis was observed within one month after BAE.In one patient the hemoptysis reappeared five months after the treatment,and the bronchial bleeding ceased after conservative therapy.All patients were followed up for at least 6 months and no pulmonary malignancy was detected by CT scans.Conclusion Smoking is one of the main risk factors for cryptogenic hymoptysis.Bronchial arteries are the primary feeder vessels in cryptogenic hemoptysis.Selective bronchial artery embolization is a highly effective and safe treatment for cryptogenic hemoptysis and this technique should be regarded as the therapy of first choice.（J Intervent Radiol,2012,21： 27-30）