支气管动脉栓塞术治疗肺结核患者大咯血的疗效

Interventional treatment of massive hemoptysis in patients with pulmonary tuberculosis

目的:探讨介入栓塞治疗肺结核患者大咯血的疗效以及影响疗效的重要因素。方法:对36例肺结核大咯血患者经股动脉穿刺插管行支气管动脉造影,以及邻近的肋间动脉、锁骨下动脉以及胸廓内动脉等血管造影,依据病情选择使用明胶海绵颗粒、Embosphere栓塞微球、聚乙烯醇颗粒及带纤维铂金弹簧圈对出血动脉行栓塞治疗,术后随访观察疗效。结果:36例肺结核病大咯血患者均获一次性成功栓塞止血,仅1例患者术后1个月复发,经再次栓塞后血止。所有患者无严重并发症。结论:介入栓塞治疗肺结核患者大咯血疗效肯定,安全可靠,即刻止血率高。术中细致观察并分析待栓塞血管的减影图像、选择适合的栓塞材料、明确微导管头端与待栓塞血管位置关系是治疗成功的关键因素。

Objective: To investigate the efficacy of interventional embolization in treating massive hemoptysis in patients with pulmonary tuberculosis and the main factors affecting the curative effect. Methods: 36 cases of pulmonary tuberculosis with large hemoptysis underwent bronchial arteriography through femoral artery intubation, and arteriography of other vessels such as adjacent intercostal artery, subclavian artery and phrenic artery was performed when necessary. After comprehensive analysis, appropriate embolic materials were selected for the treatment of bleeding artery embolization, and the curative effect was observed after the treatment. Results: Hemorrhagic artery of 36 cases of massive hemoptysis of pulmonary tuberculosis was found by arteriography. According to the condition, gelatin sponge particles, embosphere embolizing microspheres, polyvinyl alcohol particles and embolization with fiber platinum coil were selected. All the patients were successfully embolized. Only 1 patient recurred after one month and bleeding was stopped after re- embolization. There was no serious complication in this group of patients. Conclusion: Interventional embolization is safe and effective in the treatment of massive hemoptysis in patients with pulmonary tuberculosis. The key factors for successful treatment were careful observation and analysis of subtraction images, selection of suitable embolization materials and identification of the relationship between the head end of the microcatheter and the position of the vessels to be embolized.