支气管动脉畸形致大咯血的血管造影检查和栓塞治疗

Bronchial Arterial Angiography and Embolization for Massive Haemoptysis due to Bronchial Arterial Malformation

目的:探讨支气管动脉造影及栓塞术对支气管动脉畸形致大咯血的诊治价值。材料和方法:对7例不明原因的大咯血患者急诊或择期支气管动脉数字减影血管造影（DSA）检查,对异常血管用聚乙烯泡沫醇（PVA）颗粒或明胶海绵颗粒加钢圈栓塞。结果:共发现9支畸形支气管动脉,表现为一侧或双侧支气管动脉扭曲、分支增多,粗细不均,远端有弥漫造影剂浓染者3例,伴有一处或多处支气管动脉-肺动脉瘘者4例。除1例明胶海绵及钢圈栓塞患者1周内复发外,PVA栓塞者平均随访27.5月未见复发。结论:支气管动脉造影可明确致大咯血的支气管动脉畸形,栓塞治疗可望获得良好的远期疗效。

Purpose: To evaluate the role of bronchial arterial angiography and embolization in the diagnosis and treatment of bronchial arterial malformation causing massive haemoptysis.Materials and Methods: Digital subtraction angiography of the bronchial artery was performed in 7 patients with massive haemoptysis of unknown causes, and the abnormal arteries were embolized with polyvinyl alcohol parti-cles(PVA) or gelfoam particles plus coils. Results: Unilaterally or bilaterally 9 tortuous, hypertrophic and unevenly ramified bronchial ateries were discovered, with diffuse distal dense stains in 3 patients and single or multiple bronchopulmonary arterial fistula(e) in the other 4 patients.No haemoptysis recurred in 6 patients successfully embolized with PVA after a mean follow - up of 27.5 months.In one patient bleeding recurred one week after embolization with gelfoam and coils.Conclusion: Bronchial arterial angiography could reveal bronchial arterial malformation causing hemoptysis. Embolization could contribute to good long - term outcome.