Onyx胶血管内栓塞治疗急性大咯血的临床效果

Clinical effect of Onyx endovascular embolization in treating acute massive hemoptysis

目的?探讨Onyx胶血管内栓塞治疗急性大咯血的安全性及有效性。方法选取2015年3月至2017年8月因急性大咯血于我院接受Onyx胶血管内栓塞治疗的患者20例,男14例、女6例,中位年龄45.5(17~73)岁,支气管扩张10例、肺结核3例、肺癌2例、血管畸形1例、不明原因4例。其中10例为外院采用常规材料栓塞术后短期内(≤7 d)再次咯血。统计Onyx胶血管内栓塞治疗急性大咯血的技术成功率和临床成功率,分析相关并发症,并计算近期(<3个月)、中期(3~<12个月)及远期(≥12个月)复发率。结果20例患者均成功进行栓塞,术后出血均得到有效控制,技术成功率与临床成功率均达100.0%(20/20)。所有患者均未出现脊髓损伤、呼吸衰竭等严重并发症。术后中位随访时间22.5(3~42)个月,18例(90.0%)患者随访12个月以上。3例患者分别于术后1、7、15个月复发,均经内科治疗有效,未再接受血管内栓塞止血治疗。2例肺癌患者分别于术后4、10个月死于原发性肿瘤。近期复发率为5.0%(1/20),中期复发率为5.0%(1/20),远期复发率为5.6%(1/18)。结论采用Onyx胶血管内栓塞治疗急性大咯血安全、有效。

Objective To investigate the safety and efficacy of Onyx endovascular embolization in the treatment of acute massive hemoptysis.Methods Between Mar.2015 and Aug.2017,a total of 20 patients with acute massive hemoptysis received Onyx endovascular embolization in our hospital,including 14 males and 6 females,with a median age of 45.5 years(ranged 17-73 years),10 cases of bronchiectasis,3 cases of pulmonary tuberculosis,2 cases of lung cancer,1 case of arteriovenous malformation and 4 cases of cryptogenic hemoptysis.There were 10 cases experienced rebleeding after embolization with conventional agents within 7 days(transfered from other hospitals).The technical and clinical success rates and the related complications of Onyx endovascular embolization in treating acute massive hemoptysis were analyzed.The short-term(<3 months),medium-term(3-<12 months)and long-term(≥12 months)recurrence rates were calculated.Results Embolization was technically and clinically successful in all the 20 patients(100.0%)and postoperative bleeding was effectively controlled.No serious complications such as spinal cord injury or respiratory failure occurred.The median followup time was 22.5 months(3-42 months),and 18 patients(90.0%)were followed up for more than 12 months.Three patients experienced recurrent hemoptysis at 1 month,7 months and 15 months after initial embolization;all of them were treated effectively by internal medicine,and no further interventional hemostasis was given.Two cases died from the primary tumor of the lung at 4 months and 10 months after embolization.The recurrence rates of short-term(<3 months),medium-term(3-<12 months)and long-term(≥12 months)were 5.0%(1/20),5.0%(1/20)and 5.6%(1/18),respectively.Conclusion Onyx endovascular embolization is safe and effective in the treatment of acute massive hemoptysis.