老年肺结核并发肺曲霉病大咯血介入栓塞治疗

Interventional embolization treatment of massive hemoptysis in elderly patients with pulmonary tuberculosis complicated by aspergillosis

目的回顾性分析支气管动脉栓塞术(BAE)治疗老年肺结核并发肺曲霉病大咯血患者的效果。方法对15例确诊的老年肺结核并发肺曲霉病大咯血患者作支气管动脉及相关动脉造影,了解参与病变动脉类型和支数,并对责任动脉进行栓塞治疗。结果 15例患者中找到出血动脉39支,其中支气管动脉21支(53.85%),肋间动脉10支(25.64%),胸廓内动脉6支(15.38%),膈下动脉2支(5.13%),全部予以栓塞。13例(86.67%)患者即刻栓塞成功止血,1例术后24 h内再次大咯血经二次栓塞后止血,1例术后间歇少量咯血经内科对症处理后咯血停止,无严重并发症发生。结论对于内科治疗无效又无外科手术条件的肺结核并发肺曲霉病大咯血患者,BAE术是一种有效的抢救性止血方法。

Objective To retrospectively analyze the effectiveness of percutaneous bronchial artery embolization（BAE） for the treatment of massive hemoptysis due to pulmonary tuberculosis complicated by aspergillosis in elderly patients. Methods BAE and relevant angiography was performed in 15 massive hemoptysis elderly patients with confirmed pulmonary tuberculosis complicated by aspergillosis to determine the types and numbers of diseased arteries. BAE was carried out for the responsible arteries. Results A total of 39 bleeding arteries were detected in 15 patients, including bronchial artery（n=21,53.85%）, intercostal artery（n =10,25.64%）, internal thoracic artery（n =6,15.38%） and inferior phrenic artery（n =2,5.13%）.Embolization treatment was carried out for all the bleeding arteries. Immediate hemostasis after successful embolization was obtained in 13 patients（86.67%）. In one patient, massive hemoptysis appeared again within24 hours after the embolization therapy and the bleeding stopped after second embolization procedure. In another patient, intermittent and small amount of hemoptysis developed after embolizaton treatment, and the hemoptysis stopped after symptomatic treatment. No severe complications occurred. Conclusion For the treatment of massive hemoptysis caused by pulmonary tuberculosis complicated by aspergillosis, which has failed to medical treatment and is inoperable, BAE is an effective and life-saving hemostasis method.