选择性支气管动脉栓塞术在急性肺咯血治疗中的应用价值

Selective bronchial artery embolization in treatment of acute pulmonary hemoptysis

目的探讨选择性支气管动脉栓塞术在急性肺咯血治疗中的应用价值。方法收集2015年2月-2018年8月解放军联勤保障部队第909医院急诊收治的94例肺咯血行栓塞术患者的临床资料,评价其疗效。患者均行支气管动脉造影以明确支气管动脉血供及出血部位情况,对病变动脉采用微导管超选择性支气管动脉插管,给予明胶海绵、聚乙烯醇(PVA)颗粒、弹簧圈等材料栓塞止血。结果94例患者中,男性76例,女性18例,年龄23~91岁,平均61岁。主要病因包括肺肿瘤、肺结核、肺脓肿、支气管扩张、外伤等。91例行栓塞后咯血停止,3例再次出现咯血,总有效率达96.8%(91/94)。2例患者术后出现低热、肋间疼痛等症状,未予特殊处理,症状自然缓解。未见脊髓损伤、异位栓塞等严重并发症发生。结论支气管动脉栓塞术对肺咯血行内科保守治疗无效患者是一种有效、安全、微创的治疗方法。

Objective To explore the value of selective bronchial artery embolization in treatment of acute pulmonary hemoptysis.Methods Clinical data about 94 patients with pulmonary hemoptysis undergoing embolization in the emergency department of our hospital from February 2015 to August 2018 were collected and evaluated.All patients underwent bronchial angiography to determine the blood supply and bleeding site of the bronchial artery.Microcatheter super selective bronchial artery cannulation was used for the diseased artery,and embolization was performed with embolization materials such as gelatin sponge,polyvinyl alcohol(PVA)particles and coils to stop bleeding.Results Of the 94 patients,there were 76 males and 18 females,aged from 23 to 91 years(mean age of 61 years old).The main causes of pulmonary hemoptysis were lung cancer,tuberculosis,lung abscess,bronchiectasis,and trauma.Bleeding was stopped in 91 patients after embolization,with the total effective rate of 96.8%(91/94).But hemoptysis occurred again in 3 cases.Two patients developed symptoms such as hypothermia,intercostals pain,etc after surgery.No special treatment was given and the symptoms were naturally relieved.No serious complications such as spinal cord injury or ectopic embolism occurred.Conclusion Bronchial artery embolization is an effective,safe and minimally invasive treatment for patients with pulmonary hemoptysis can not be controlled by medical treatment.