动脉栓塞术治疗大咯血15例临床分析

Clinical analysis of 15 cases with large hemoptysis treated by arterial embolism

目的 探讨供应肺组织的体循环血管起源情况及动脉栓塞治疗大咯血的技术问题。方法 对 15例大咯血患者采用Seldinger技术穿刺右侧股动脉 ,引入 5FCobra管 ( 4例还使用SP微导管 )至靶血管造影 ,明确诊断后注入PVA颗粒进行栓塞 ,观察治疗效果及不良反应。结果 13例由降主动脉发出的支气管动脉供血(其中 4例支气管动脉与脊髓动脉共干 ) ,1例由胸廓内动脉供血 ,1例由胸廓内动脉与支气管动脉共同参与供血。 14例患者术后 3d血止 ,1例 2d后再发大咯血 ,再次造影发现病灶同时还有胸廓内动脉参与供血 ,栓塞胸廓内动脉后血止。 15例患者均未见明显不良反应 ,随访半年未见复发。结论 用PVA颗粒栓塞靶血管治疗大咯血临床疗效佳。对支气管动脉与脊髓动脉共干者使用微导管行动脉超选可减少脊髓损伤。栓塞术中应考虑到血管起源变异可能。

Objective To investigate the vessel origin of systemic circulation that supplies the lungs and the techniques of arterial embolism applied to large hemoptysis. Method 15 cases with large hemoptysis were treated by embolism with PVA granules through right femoral arteries punctured with the Seldinger technique, 5F Cobra catheter introduced (SP microcatheters were utilized in 4 cases) to the target vessel and angiography made once the diagnosis were determined. Clinical effects and side effects were observed. Result The lungs of 13 cases were supplied by the bronchial artery that originated from the descending aorta,the lungs of 1 case were supplied by the internal thoracic artery,and the other one were supplied both by the bronchial artery and internal thoracic artery. Hemoptysis of 14 cases stopped on the third day after operation and one case reoccurred after 2 days. In the reoccurred case, angiography was made again and the lung was found to be also supplied by the internal thoracic artery, and hemoptysis stopped after internal thoracic embolism. All patients had no distinct side effect and did not reoccur in the following half a year.Conclusion The clinical effect of target arterial embolism with PVA granules on large hemoptysis treatment was perfect. The different artery origins should be taken into considerations in the arterial embolism technique.