急诊经导管动脉栓塞治疗肺结核大咯血

Emergent transcatheter arterial embolization for massive hemoptysis due to tuberculosis

目的探讨肺结核大咯血的急诊动脉栓塞(TAE)治疗策略及疗效。方法对38例因肺结核致大咯血患者行急诊经导管动脉造影,明确出血部位后,选用明胶海绵条、弹簧圈及聚乙烯醇(PVA)颗粒对出血动脉行TAE,对治疗结果进行回顾性评价。结果对所有患者均成功栓塞出血动脉。29例栓塞后24h咯血停止;9例栓塞后仍有少量咯血,经保守治疗1～2周后症状消失。术后随访6～20个月,3例1年后复发,行2～3次栓塞治疗后仍有大量出血,转外科治疗。所有患者均未出现严重并发症。结论急诊TAE治疗肺结核所致大咯血安全、有效;彻底全面地栓塞出血动脉是治疗成功的关键。

Objective To explore the strategy and clinical effect of emergent transcatheter arterial embolization （TAE） in patients with massive hemoptysis due to pulmonary tuberculosis. Methods Totally 38 patients underwent emergent selec- tive angiography for massive hemoptysis due to tuberculosis. Gelatin sponge, coils and polyvinyl alcohol （PVA） particles were used to embolize the bleeding arterials when they were confirmed. Clinical effects from all 38 patients were reviewed retrospectively. Results TAE of bleeding arteries were successfully performed in 38 patients, and hemoptysis was com- pletely controlled after embolization in 29 patients, while it obviously alleviated in 9 patients who received medicine treat- ment, and disappeared completely 1--2 weeks later. The patients were followed up for 6--20 months. Recurrence of he- moptysis after TAE was found in 3 patients after one year＇s interval, and hemoptysis was not completely controlled after the second and three times of TAE, and then operation had to be employed. No serious complication occurred. Conclusion E- mergent TAE of bleeding arteries is safe and effective for the treatment of massive hemoptysis due to pulmonary tuberculo- sis, and the key of successful TAE treatment is to embolize bleeding arterials as far as possible.