介入栓塞治疗肺动脉假性动脉瘤伴大咯血的临床疗效分析

Endovascular embolization for pulmonary artery pseudoaneurysms with massive hemoptysis

目的 探讨体肺双途径栓塞治疗肺动脉假性动脉瘤(pulmonary artery pseudoaneurysms,PAPs)伴大咯血的临床疗效及安全性.方法 回顾性分析2016年1月至2018年2月海南医学院第二附属医院收治的经CT血管造影(CT angiography,CTA)/数字减影血管造影(digital subtractive angiography,DSA)证实为PAPs伴大咯血的15例肺结核患者的临床资料.记录相关影像学表现、介入治疗技术和临床止血成功情况,随访1年内咯血复发状况.结果 共发现15个PAPs,肺CTA发现14个,血管造影发现1个.术中仅支气管动脉造影发现6个,仅肺动脉造影发现4个,支气管动脉及肺动脉造影均发现4个,1个体肺动脉造影均未发现.介入栓塞术后咯血有效止血14例,1例患者术中因大咯血窒息导致死亡.患者随访12个月,其中1例患者术后2周复发大咯血行外科切除术;1例咯血术后3个月余复发,再次行介入栓塞后咯血停止.结论 经体肺双途径栓塞治疗肺结核患者PAPs伴大咯血的临床疗效确切,方法可行,但仍有一定风险.

Objective To investigate the efficacy and safety of transcatheter embolization for the treatment of pulmonary artery pseudoaneurysms(PAPs)with massive hemoptysis via both arterial and venous access.Methods The clinical data of 15 patients of pulmonary tuberculosis presenting with massive hemoptysis,who were confirmed by CTA/DSA with PAPs at the Second Affiliated Hospital of Hainan Medical University from January 2016 to February 2018,were retrospectively analyzed.The imaging presentation,technical and clinical success of endovascular treatment,and recurrence of hemoptysis within 1 year was recorded.Results A total of 15 PAPs were involved.Fourteen PAPs were confirmed by pulmonary CTA and one by angiography.Six PAPs were visualized during bronchial artery angiography,4 PAPs during pulmonary artery angiography,and 4 PAPs both.One PAP was not shown during catheter-directed angiography.Except for one patient who died of asphyxia due to severe hemoptysis undergoing embolization,hemoptysis relapse was achieved in 14 patients after endovascular treatment.During 12 months follow-up,one patient underwent surgical resection because of recurrent hemoptysis 2 weeks after embolization,and another patient with recurrence hemoptysis 3 months after embolization received repeated intervention and hemoptysis relapsed.Conclusion Transcatheter embolization via dual access is effective and feasible for the treatment of PAPs with massive hemoptysis in patients with pulmonary tuberculosis,but still some risks.