不同支气管动脉栓塞方法治疗复治和初治肺结核咯血的疗效对比

Comparison of effects of different bronchial artery embolization methods in re-treatment and initial treatment of tuberculosis hemoptysis

目的评价不同支气管动脉栓塞方法治疗复治和初治肺结核咯血的临床疗效。方法回顾分析本院49例进行支气管动脉三重栓塞和双重栓塞治疗的复治和初治肺结核咯血患者。其中复治肺结核29例,行三重栓塞15例,双重栓塞14例;初治肺结核20例,行三重栓塞11例,双重栓塞9例。三重栓塞即第一级用规格350~560μm的PVA颗粒栓塞远段细小血管,第二级用规格710~1000μm的PVA颗粒栓塞中段中小血管,第三级用2 mm×4 mm的塔形纤毛弹簧圈栓塞近段主干血管;双重栓塞就是用相应规格的PVA颗粒分别栓塞远段细小血管和中段中小血管。术后随访1~3年,分析其有效率、复发原因及对策。结果49例患者一次性栓塞即刻止血48例,止血率98.0%,1例行第二次栓塞后即刻止血。总有效(治愈+显效)38例,占77.6%;30 d^3年中复发11例,复发率22.4%。29例复治肺结核行支气管动脉三重栓塞15例,有效13例,复发2例,有效率86.7%(13/15);另外14例行支气管动脉双重栓塞,有效8例,复发6例,有效率57.1%(8/14)。20例初治肺结核行三重栓塞11例,有效10例,复发1例,有效率90.9%(10/11);另外9例行双重栓塞,总有效7例,复发2例,有效率77.8%(7/9)。结果显示,复治肺结核咯血三重栓塞与双重栓塞有效率比较,差异有统计学意义(P<0.05)。初治肺结核咯血三重栓塞和双重栓塞有效率比较,差异无统计学意义(P>0.05)。复发主要原因是漏栓和侧支循环形成。结论BAE治疗肺结核咯血止血快,疗效好,根据咯血类型选择最佳栓塞方法,有效防止漏栓和预防侧支循环再生,有助于降低肺结核咳血的复发率。

Objective To evaluate the clinical effects of different bronchial artery embolization(BAE)methods in the re-treatment and initial treatment of tuberculosis hemoptysis.Methods A total of 49 patients with tuberculosis hemoptysis re-treated and initially treated with triple and double BAE in our hospital were retrospectively analyzed.There were 29 cases of re-treated tuberculosis:15 cases were treated with triple embolization and 14 cases with double embolization;and there were 20 cases of initially treated tuberculosis:11 cases were treated with triple embolization and 9 cases with double embolization.The triple embolization was as follows:at the first stage,350-560μm PVA particles were used to embolize the distal small vessels;at the second stage,710-1000μm PVA particles were used to embolize the middle small and medium vessels;at the third stage,2 mm×4 mm tower-shaped ciliated spring ring was used to embolize the proximal main vessels.The double embolization was as follows:PVA particles of corresponding specifications were used to embolize the distal small vessels and middle small and medium vessels,respectively.The patients were followed up for 1 to 3 years,and the effective rate,causes of recurrence,and countermeasures were analyzed.Results There were 48 cases of immediate hemostasis after the first embolization in 49 patients,accounting for 98.0%,1 case of immediate hemostasis after the second embolization.There were 38 total effective(cured+effective)cases,accounting for 77.6%;the disease recurred in 11 patients during 30 d^3 years after the operation,with the recurrence rate of 22.4%.Among 29 cases of re-treated tuberculosis:15 cases were treated with triple BAE,there were 13 effective cases and 2 cases of recurrence,with the effective rate of 86.7%(13/15);the other 14 cases were treated with double BAE:there were 8 effective cases and 6 cases of recurrence,with the effective rate of 57.1%(8/14).Among 20 cases of initially treated tuberculosis:11 cases were treated with triple BAE:there were 10 effective cases and 1 case of recurrence,with the effective rate of 90.9%(10/11);the other 9 cases were treated with double BAE:there were 7 effective cases and 2 cases of recurrence,with the effective rate of 77.8%(7/9).The results showed that the difference in the effects in the re-treatment of tuberculosis hemoptysis with triple embolization and double embolization was statistically significant(P<0.05);the difference in the effects in the initial treatment of tuberculosis hemoptysis with triple embolization and double embolization was not statistically significant(P>0.05).The main causes of recurrence were embolization leakage and the formation of collateral circulation.Conclusion BAE has good and quick effects in treating tuberculosis hemoptysis.The selection of the optimum embolization according to the type of hemoptysis can effectively prevent embolization leakage and the regeneration of collateral circulation and helps to reduce the recurrence rate of tuberculosis hemoptysis.