儿童咯血介入栓塞治疗后复发8例

Recurrence of hemoptysis after interventional embolization in 8 sick children

目的分析儿童咯血经导管支气管动脉栓塞术(BAE)后复发的原因,为预防复发提供支持。方法回顾性分析2014年6月至2018年6月46例咯血患儿经BAE治疗后复发的8例临床资料,通过支气管动脉再次造影综合分析复发原因。结果BAE术后8例咯血复发患儿再次造影发现,复发咯血由原责任血管再通所致2例,异常供血支气管动脉遗漏栓塞所致2例,病灶新生侧支循环供血动脉建立所致3例,血管变异超选失败所致1例。二次BAE治疗后随访6个月至3年。7例患儿未再出现咯血症状,1例再次出现咯血,给予外科右肺下叶切除后治愈。结论BAE可有效治疗咯血,完全栓塞是关键。但术中造影应仔细,避免遗漏,再通和新发动脉也值得注意,是咯血复发原因之一。

Objective To analyze the causes of hemoptysis recurrence in sick children with hemoptysis after bronchial artery embolization(BAE)treatment so as to provide theoretical support for preventing recurrence.Methods A total of 46 sick children with hemoptysis were treated with BAE during the period from 2014 to2018 at authors’hospital.Among them,8 sick children developed recurrent hemoptysis,and their clinical data were retrospectively analyzed.Reexamination of bronchial arteriography was carried out,and the causes of hemoptysis recurrence were comprehensively analyzed.Results In the 8 sick children with recurrent hemoptysis after BAE,angiograpy showed that the causes of hemoptysis recurrence included recanalization of primary responsible vessels(n=2),missing embolization of bronchial artery providing abnormal blood supply(n=2),newly-established collateral circulation blood supply artery(n=3)and failure of super-selective catheterization due to variation of vascular anatomy(n=1).BAE treatment was carried out once again,and the sick children were followed up for 3-36 months.Hemoptysis no longer occurred in 7 sick children.One sick child developed recurrence of hemoptysis,the surgical resection of right lower lobe had to be carried out and the sick child was cured.Conclusion Interventional percutaneous BAE can effectively treat hemoptysis,and complete occlusion of the responsible vessel is the therapeutic key point.The intraoperative angiographic findings should be carefully observed,all the blood supply arteries of the lesion should not be missed.The recanalization of primary responsible vessels and the establishment of new collateral circulation blood supply arteries are the main causes of recurrent hemoptysis.(J Intervent Radiol,2020,29:1021-1024)