支气管扩张大咯血的急诊介入栓塞治疗

Emergency embolization therapy for massive hemoptysis due to bronchiectasis

目的探讨90例支气管扩张大咯血患者的动脉造影表现及急诊介入栓塞治疗的疗效。方法对90例支气管扩张大咯血的患者行急诊动脉造影检查,明确出血部位后,选用不同的栓塞剂栓塞出血动脉,对动脉造影的表现及治疗结果进行回顾性总结及评价。结果 90例患者共找到135支出血动脉,全部成功栓塞治疗。栓塞术后随访12个月,8例患者复发咯血,6例采用肺叶切除手术后出血停止。2例患者死于结核菌合并曲霉菌感染所致的并发症。栓塞治疗的总有效率91.11%(82/90)。栓塞术后无严重并发症出现。结论急诊动脉栓塞治疗支气管扩张大咯血是一种安全、有效的治疗手段。合理选择和使用栓塞剂及彻底全面栓塞出血动脉是治疗成功的关键。

Objective To identify various arteriographic manifestations of massive hemoptysis due to bronchiectasis and the efficacy of emergency embolization .Methods Emergency arteriography was performed for 90 patients of bronchietasis with massive hemoptysis .Emergency embolization was conducted using embolic agents as soon as bleeding arteries were i‐dentified .The arteriographic manifestations and effect of the treatment for massive hemoptysis were retrospectively ana‐lyzed .Results 135 bleeding arteries were found and be embolized succefully in 90 patients .A 12‐month follow‐up re‐vealed that complete hemostasis was achieved in 84 patients within 24 hours ,6 hemoptysis stopped completely in 3 days of embolotherapy .8 patients had recurrent hemoptysis ,among whom 6 hemoptysis stopped completely after lobectomies ,2 patients died of the complications of TB/aspergillus coinfection .The overall effective rate of the emergency embolization was 91 .11% （82/90） .No serious complications occurred after embolotherapy .Conclusion Emergency arterial emboliza‐tion for hemoptysis of bronchiectasis is a safe and effective treatment for massive hemoptysis due to bronchiectasis .The key to successful treatment is reasonable choice and use of embolic agents and thorough and complete embolization of the bleeding arteries .