顽固性咯血患者肺叶切除术前行动脉栓塞介入治疗的价值

The value of arterial embolization before pulmonary lobectomy in patients with refractory hemoptysis

目的 探讨数字减影血管造影（DSA）引导下超选择性经导管动脉栓塞介入治疗（简称“介入栓塞治疗”）在顽固性咯血患者行肺叶切除术前的应用价值。方法 回顾性分析我院连续收治的 45例因顽固性咯血入院,需施行肺叶切除术患者的临床资料。将肺叶切除术术前进行介入栓塞治疗的20例患者作为研究组,将未施行术前介入栓塞治疗的25例患者作为对照组。观察两组患者引起咯血的责任血管分布情况、与原发病的关系及介入栓塞治疗的效果。对比两组患者手术时间、出血量及并发症发生率等指标的差异。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验,均以P〈0.05为差异有统计学意义。结果 DSA检查发现研究组20例患者共有出血责任血管 57支,其中支气管动脉（BA）12支,非支气管性体动脉（NBSA）侧支循环42支,肺动脉（PA） 3支;研究组结核性毁损肺及肺空洞并发曲菌球患者（11例）的NBSA 以肋间动脉、锁骨下动脉及腋下动脉为主（共29支）,支气管扩张患者（9例）的NBSA以食管固有动脉、膈下动脉为主（共13支）。介入栓塞治疗后即刻止血13例,占65.0%,咯血减少7例,占35.0%。研究组患者术中出血量平均为（600±155）ml,对照组患者术中出血量平均为（850±210）ml,两组比较差异有统计学意义（t=23.73,P=0.000）;研究组患者手术时间为（150±35）min,对照组患者手术时间为（180±40）min,两组比较差异有统计学意义（t=12.40,P=0.000）。结论 NBSA为顽固性咯血的主要责任血管,其分布规律与原发病相关;术前行介入栓塞治疗有助于控制咯血,并能有效减少术中出血,缩短手术时间,从而降低手术风险。

Objective To evaluate the value of superselective transcatheter arterial embolization （interventional embolization） guided by digital subtraction angiography （DSA） before pulmonary lobectomy in patients with refractory hemoptysis. Methods We analyzed retrospectively the clinical data of 45 consecutive patients admitted in Shandong Provincial Chest Hospital due to refractory hemoptysis requiring lobectomy. Twenty patients underwent interventional embolization before lobectomy as research group, and 25 patients without interventional embolization before lobectomy as control group. The distribution of blood vessels responsible for hemoptysis, the relationship between primary disease and the effect of interventional embolization were observed. The differences in operative time, bleeding volume and incidence of complications between the two groups were compared. T test was used to compare the measurement data between groups, and χ2 test was used to compare the enumeration data between groups, with P〈0.05 as the statistical significance. Results DSA revealed that there were 57 vessels responsible for bleeding in 20 patients in the research group, including 12 bronchial arteries （BA）, 42 collateral arteries of non-bronchial body arteries （NBSA）, and 3 pulmonary arteries （PA）. Of 42 NBSA branches,29 branches were from intercostal artery, subclavian artery and axillary artery,in 11 cases with tuberculous destroyed lung and cavity complicated with aspergillus ball, and 13 branches were from esophageal proper artery and inferior phrenic artery in 9 cases with bronchiectasis. There were 13 （65.0%） cases of hemostasis immediately stop after interventional embolization, and 7 （35.0%） cases hemoptysis alleviating. The average intraoperative bleeding volume was （600±155）ml in the research group and that was （850±210）ml in the control group. There was significant difference between the two groups （t=23.73,P=0.000）. The operative time was （150±35）min in the research group, and that was （180±40）min in the control group. The difference between the two groups was statistically significant （t=12.40,P=0.000）.Conclusion NBSA is the main blood vessel responsible for refractory hemoptysis, and its distribution is related to the primary disease. Preoperative interventional embolization is helpful to control hemoptysis, and can effectively alleviate intraoperative bleeding, shorten the operation time, thereby reducing the risk of operation.