急诊动脉栓塞治疗支气管动脉—肺静脉瘘大咯血

Emergency transcatheter arterial embolisation for massive hemoptysis due to bronchial artery to pulmonary vein fistula

目的探讨支气管动脉—肺静脉瘘大咯血患者的血管造影表现及急诊动脉栓塞(ETAE)治疗的疗效。方法11例支气管动脉-肺静脉瘘大咯血患者采用急诊介入造影检查,明确出血部位后,采用聚乙烯醇(poly vinyl alcohol,PVA)颗粒及明胶海绵条对出血动脉行急诊栓塞治疗,对动脉造影表现及治疗结果进行回顾性分析。结果 11例患者共找到并成功栓塞26支病变的动脉。所有患者咯血3日内完全停止。栓塞术后随访16个月,所有患者均无再次咯血,且所有患者栓塞术后无严重并发症出现。结论 ETAE治疗支气管动脉-肺静脉瘘大咯血是一种安全、有效的治疗手段。准确找到出血动脉是治疗成功的前提,合理选择栓塞剂及彻底栓塞出血动脉是治疗成功的关键。

Objective To analyse the manifestations of angiography and the curative effect of emergency transcatheter ar terial embolisation （ETAE） in patients with massive hemoptysis due to bronchial artery to pulmonary vein fistula. Methods 11 cases of massive hemoptysis due to bronchial artery to pulmonary vein fistula underwent emergency arteriography. Af ter bleeding arteries were located, the patients were given embolotherapy with gelfoam strips and polyvinyl alcohol （PVA） particles. The arteriography manifestations and therapeutic outcome from all 11 patients were retrospectively analysed. Results 26 bronchial arteries were located and embolized successfully in 11 patients. Hemoptysis of all patients was stopped in 3 days after embolotherapy. During 16month followup, there were no rebleedings and severe complications. Conclusion ETAE is a safe and effective treatment for the massive hemoptysis due to bronchial artery to pulmonary vein fistula. The premise of successful treatment is to locate the bleeding arteries accurately, and the key of successful treat ment is to thoroughly and completely embolize the bleeding arterials.