支气管动脉CTA与支气管动脉栓塞术在反复少量咯血患者中应用

Application of bronchial artery CTA and bronchial artery embolization in patients with recurrent small amount hemoptysis

目的探寻反复少量咯血患者行BAE治疗后疗效以及BA-CTA对少量咯血患者手术的指导作用。方法我院2017年1月至2019年6月收治的反复少量咯血患者123例,其中介入组65例,介入组57例术前行BA-CTA检查,对照组58例,统计介入组技术及临床成功率,并发症发生情况,比较BA-CTA与DSA血管检出情况,比较两组1年内的咯血复发率、大咯血率及95%CI。结果将BA-CTA与DSA检出血管数量作比较,P<0.05,获得BA-CTA的敏感度为96.7%,特异性为100%。介入组技术及临床成功率为100%。介入组复发率16.9%,其中大咯血率为1.5%,对照组复发率34.5%,其中大咯血率为10.3%,P<0.05,差异具有统计学意义。介入组95%(CI为0.076-0.263),对照组5%(CI为0.219-0.471),介入组相对对照组的RR值为0.387。介入组术后3例偶有胸痛,3例偶有背痛,1例排尿困难,经对症治疗缓解。结论术前行BA-CTA检查可帮助责任血管检出,对介入手术有指导作用,反复少量咯血患者行栓塞治疗可有效降低咯血复发率及大咯血率,但是仍需更多研究证实。

Objective To explore the efficacy of BAE in patients with recurrent small amount hemoptysis and the guiding role of BA-CTA in the operation of patients with recurrent small amount hemoptysis.Methods A total of 123 patients with recurrent small amount hemoptysis treated in our hospital from January 2017 to June 2019 were analyzed retrospectively,including 65 cases of the interventional group with bronchial artery embolization,57 cases of preoperative BA-CTA examination in the interventional group,58 cases in the control group.The technical and clinical success rate of the interventional group,the incidence of complications and the detection of blood vessels of BA-CTA and DSA were compared.The recurrence rate of hemoptysis and the rate of massive hemoptysis within one year were compared between the two groups.Results Comparing the number of blood vessels detected by BA-CTA and DSA,the sensitivity and specificity of BA-CTA were 96.7%and 100%,respectively.The technical and clinical success rate of the intervention group was 100%.The recurrence rate was 16.9%in the intervention group,in which the rate of massive hemoptysis was 1.5%,and that of the control group was 34.5%,of which the rate of massive hemoptysis was 10.3%(P<0.05).The 95%CI of the intervention group was 0.076-0.263,the 5%CI of the control group was 0.219-0.471,and the RR of the intervention group was 0.387 compared with the control group.In the interventional group,3 cases had occasional chest pain,3 cases had occasional back pain and 1 case had dysuria,which was relieved by symptomatic treatment.Conclusion Preoperative CTA examination can help to detect responsible vessels and guide interventional operation.Embolization in patients with repeated small amount hemoptysis can effectively reduce the recurrence rate of hemoptysis and the rate of massive hemoptysis,but more studies are still needed.