比较隐源性咯血和慢性肺结核咯血动脉造影表现及栓塞治疗效果

Characteristics and effect of arterial embolization of cryptogenic hemoptysis and chronic tuberculosis

目的比较顽固性隐源性咯血(CH)和慢性肺结核(CTB)咯血的动脉造影表现特点及介入栓塞治疗效果。方法对17例顽固性CH患者(CH组)及20例CTB咯血患者(TB组)行责任血管栓塞,比较两组责任血管数目、非支气管体循环动脉(NBSA)参与供血血管数目、血管造影表现及栓塞后中远期效果。结果 TB组人均责任血管数目、NBSA参与供血血管数目多于CH组(t'=5.469,t=5.212,P<0.01);TB组血管增粗、纡曲、富血管化、BP分流及动静脉瘘的发生率均高于CH组(P均<0.05)。TB组术后2年复发率高于CH组(P<0.01)。CH组和TB组并发症发生率分别为64.71%(11/17)、95.00%(19/20),差异无统计学意义(P>0.05)。结论支气管动脉是CH的主要责任血管。CTB咯血因存在大量NBSA供血,责任血管复杂。CTB咯血复发率高,与栓塞不彻底有关。根据造影特点选择栓塞剂及决定栓塞程度可预防严重并发症。

Objective To compare the characteristics and effect of interventional embolization of eryptogenic hemoptysis （CH） and chronic tuberculosis （CTB）. Methods Seventeen patients of conservative uncontrollable refractory CH and 20 patients of CTB were treated with artery embolization. The numbers of responsible vessels, numbers of non-bronchial systemic arteries, the characteristics and effect of interventional embolization were retrospectively analyzed. Results There were more responsible vessels and non-bronchial systemic arteries in TB group than in CH group （t= 5. 469, t=5. 212, P 〈0.01）. The incidences of vascular enlargement, circuity, rich vascularization, BP shunt and arteriovenous fistula in TB group were higher than those in CH group （P〈0.05）. The 2-year recurrence rate in TB group was higher than that in CH group （P〈0.01）. The incidence of complications in CH and TB group were 64.71% （11/17） and 95.00% （19/20） ,retrospectively （P〉0.05）. Conclusion Bronchial arteries are the main responsible vessels for CH. The responsible vessels for CTB are complicated due to non-bronchial systemic arteries （NBSA）. Higher hemoptysis recurrence rate in CTB is found related to incomplete embolization of feeding vessels. Choosing embolizing agent according to imaging characteristics and determining embolization degree are very important to prevent serious complications.