大咯血介入治疗术后复发原因与对策

The causes and countermeasures of recurrence following interventional theapy for massive hemoptysis

目的:探讨顽固性大咯血介入治疗术后复发原因及处理措施。方法:对36例大咯血介入治疗术后复发出血患者行CT平扫、CTA及DSA检查,寻找出血责任血管,分析复发原因,并通过栓塞(PVA/明胶海绵)→药物灌注(垂体后叶素)→再栓塞(弹簧圈)的过程,再次行永久性栓塞治疗,并观察疗效。结果:36例患者CT及CTA示基础病变进展11例、血管漏栓10例、栓塞血管再通8例、非支气管性体动脉(NBSA)参与供血18例、侧枝形成5例、支气管动脉-肺动脉瘘2例,其中有两种或两种以上情况同时存在13例。DSA示出血责任血管55支,其中支气管动脉(BA)31支,NBSA 20支,肺动脉(PA)4支,36例再次介入栓塞后即刻止血32例(32/36)。结论:对顽固性咯血患者肺部病因治疗是防止栓塞后复发出血的重要因素,寻找出血责任血管是全面、永久栓塞治疗的关键,栓塞材料的选择和方法是提高成功率的基础。

Objective：To explore the causes and treatments of recurrence in the interventional therapy of refractory massive hemoptysis. Methods：Plain CT,CTA and DSA were performed in 36 patients with recurrent hemorrhage after in- terventional therapy. Responsible vessels were searched and causes were analyzed, then permanent embolizations were per formed again with the PVA,pituitrin and spring coil. The curative effects were observed. Results： In 36 patients,the causes of recurrence included disease progression 11 cases, missing of embolization 10 cases, recanalization 8 cases, NBSA supplying 18 cases,collateral formation 5 cases,broncho-pulmonary artery fistula 2 cases and co-existence of two or more conditions 13 cases. There were totally 55 responsible vessels shown on DSA,including 31 bronchial arteries, 20 N BSA, and 4 pulmo nary arteries. The rate of permanent haemostasis after once again embolization was 88.9 % （32/36）. Conclusion：In patients with refractory massive hemoptysis,the etiological treatment is an important factor in preventing recurrence of bleeding af- ter embolization. To find out responsible vessels is the key to comprehensive and permanent embolization,and the choice of embolic materials is essential for success rate.