支气管动脉栓塞治疗咯血40例分析

An analysis of 40 cases with hemoptysis treated by bronchial artery embolization

目的分析支气管动脉栓塞（BAE）治疗咯血的疗效及其复发原因。方法行BAE治疗咯血患者40例。其中，支气管扩张18例，肺癌13例，肺炎6例，病因不明3例。术后随访6～36个月。结果术后即刻止血39例。术后并发症主要为发热及胸痛。随访期间，28例无复发，治愈率70．o％；11例复发，复发率27．5％。8例咯血复发者再次行BAE治疗，造影证实复发原因为遗漏责任血管3例，短期责任血管再通1例，病理性血管末梢重获血供并再次显影4例。结论BAE治疗多种病因咯血疗效确切，严重并发症罕见。

Objective To analyze the clinical efficacy of bronchial artery embolization（BAE） in treating hemoptysis and its causes for recurrence. Methods A total of 40 patients with hemoptysis was treated by BikE. Hemoptysis was caused by bronchiectasis in 18 cases, malignancy in 13 cases, pneumonia in 6 cases and undefined reasons in 3 cases. The patients were followed up for 6 to 36 months after BAE. Results The immediate hemostasis was obtained in 39 cases. The main complications after BAE were fever and chest pain. During follow up, 28 patients（70. 0%） had no recurrence of hemoptysis. The recurrent hemoptysis was seen in 11 patients （27. 5%）. The eight patients with recurrent hemoptysis underwent the second BAE and had no recurrence thereafter. The causes for recurrence included the missing embolization of responsible arteries in 3 cases, the recanalization of embolized responsible arteries in 1 case, and the pathological peripheral branch of arteries in 4 cases, which restored blood supply and developed again. Conclusion The technique of BAE is an effective method for hemoptysis due to various etiologies. The severe complications of BAE are rare. The recurrence of hemoptysis after BAE can be reduced by improving the imaging examination before BAE, finding out and using unabsorbable embolization particles to occlude all the responsible arteries completely and treating the primary disease actively.