支气管动脉栓塞介入治疗支气管扩张大咯血205例疗效分析

Efficacy of Bronchial Arterial Embolization in Treatment of Massive Hemoptysis due to Bronchiectasis: 205 Cases Analysis

目的评价支气管动脉栓塞术治疗支气管扩张大咯血的临床疗效。方法 2005年4月至2012年1月205例大咯血患者经选择性支气管动脉造影后,对病变动脉采用微导管超选择性支气管动脉插管,用弹簧钢圈、聚乙烯醇微球、丝线线段、明胶海绵进行栓塞止血,评价其临床疗效和安全性。结果左右支气管动脉栓塞35例,左支气管动脉栓塞20例,右支气管动脉栓塞126例,左右支气管动脉共干栓塞22例,右膈下动脉供血栓塞2例。治愈169例,显效24例,无效12例。总有效率为94.1%,治愈率为82.4%。23例患者术后出现胸痛和低热,未予特别处理,自行缓解。未出现脊髓损伤及异位栓塞等严重并发症。结论支气管动脉栓塞介入治疗是支气管扩张大咯血患者一种安全、有效、快速的治疗方法,可作为其首选方案。

Objective To evaluate the clinical effects of bronchial artery embolization （BAE） for massive hemoptysis due to bronehiectasis. Methods 205 patients with massive hemoptysis were treated with bronchial artery embolization using coils, polyvinyl alcohol （PVA） microspheres, line segmen, and gelatin sponge after the site of bleeding or the abnormal arteries were identified by arteriography. Super selective bronchial artery embolization was performed with a coaxial microcatheter inserted into the bronchial artery. Results BAE was successfully performed in 205 cases with massive hemoptysis （left and right bronchial artery embolization in 35 cases, left bronchial artery embolization in 20 cases, fight bronchial artery embolization in 126 cases, common bronchial artery embolization in 22 cases, right inferior phrenic artery embolization in 2 cases）. Of 205 patients, 169 were cured,24 were relieved with a success rate of 94. 1%. Long term cumulative hemoptysis nonrecunrence rates was 82.4%. 23 patients developed post embolization syndrome characterized by mild fever and chest pain and ended with spontaneous recovery without special management. No severe complications including spinal cord injury or dystopia embolization were observed. Conclusions Bronchial arterial embolization interventional therapy is a rapid, safe and effective method in the treatment of massive bemoptysis due to bronchiectasis.