13例隐源性大咯血介入栓塞治疗的回顾性分析

Retrospective Analysis 13 Cases of Cryptogenic Massive Hemoptysis with Interventional Embolization

目的探讨隐源性咯血的病因、血供来源及血管内栓塞治疗效果。方法搜集大咯血患者13例,术前均经CT和/或支气管镜检查证实肺内无原发病灶。结合CT支气管动脉血管成像(CTBA)明确责任血管,所有患者均成功插管并进行支气管动脉数字减影血管造影(DSA),对责任血管进行栓塞治疗。术后观察止血效果并进行随访。结果 DSA发现支气管动脉共31支,右肺17支,左肺14支。DSA表现为支气管动脉主干增粗,末梢血管网增生,未见明显对比剂外溢征象,2例伴肺动脉分流。支气管动脉增粗(主干≥2 mm)25支,正常(主干<2 mm)6支。栓塞后所有患者即刻咯血停止,血痰颜色由鲜红逐渐转为黑褐色。1例复发。结论隐源性咯血的病变血管源于支气管动脉,与长期吸烟及慢性阻塞性肺疾病有关,血管内介入栓塞安全有效。

Objective To discuss the findings of cryptogenic massive hemoptysis and to evaluate interventional embolization in treatingthe same Methods 13 patients with hemoptysis in our hospital were Collected. CT and（ or） Bronchoscopy confirmed that there is no primary lesion in the preoperative lung. DSA angiography of bronchial artery and thoracic aorta were successfully accomplished in all patients,and all the lesions of vessels were embolized To observe the postoperative hemostatic effect and follow up. Results All lesions of vessels（ 31） were bronchial arteries,the right lung with 17,left lung with 14. Hyperplasia of the peripheral broncho arterial vessels were the major symptoms,no significant contrast spills signs,2 cases with pulmonary circulation fistula. 25 bronchial artery were augmented（ ≥ 2 mm）,6 bronchial artery normal（ 〈 2 mm）. All cases with hemoptysis stopped after embolization,recurrent massive hemoptysis of 1 case was noticed during the follow-up period. Conclusion The primary lesions in vessels of cryptogenic massive hemoptysis were in bronchial artery,the lesions were clear in DSA angiography,and Interventional embolization were safe and effective.