支气管动脉及非支气管动脉体循环栓塞治疗大咯血效果分析

Analysis of the Efficacy of Bronchial Arterial Embolization Together with Non-Bronchial Systemic Artery Embolization for Treating Massive Hemoptysis

目的探讨经支气管动脉及非支气管动脉体循环栓塞(BAE+NBSAE)治疗大咯血临床效果。分析BAE+NBSAE术后短期再出血原因。方法回顾性分析2017年3月至2020年3月我院经支气管动脉栓塞(BAE)和(或)非支气管动脉体循环栓塞(NBSAE)栓塞治疗51例大咯血临床资料。结果51例患者术后45例咯血即刻停止,6例栓塞无效仍有出血(3例术后二次栓塞成功止血,分别漏栓左锁骨下动脉分支、膈动脉及右锁骨下异位支气管动脉;2例继续药物保守治疗咯血好转,1例自动出院)。随访中3例术后1~3个月内大咯血复发、造影存在漏栓锁骨下动脉分支,食管固有动脉,异位支气管动脉及原栓塞血管再通,再次栓塞成功止血。结论BAE和NBSAE栓塞术治疗大咯血疗效确切,但是栓塞不彻底,忽视异位支气管动脉及异常体循环血管,栓塞血管再通为短期再出血主要原因。

Objective To investigate the clinical efficacy of bronchial arterial embolization(BAE)together with non-bronchial systemic artery embolization(NBSAE)for treating massive hemoptysis and analyze the cause of short-term hemoptysis after BAE and NBSAE.Methods The clinical data of 51 patients with massive hemoptysis,who received BAE and NBSAE during 2017.3-2020.3 in our hospital, were retrospectively analyzed.Results Of the 51 patients, 45 cases of hemoptysis stopped immediately after operation, and 6 cases still had bleeding after embolization(postoperative embolization was successful in 3 cases,respectively with the left subclavian artery branch, diaphragmatic artery and right subclavian ectopic bronchial artery. 2 cases continued conservative treatment of hemoptysis improved, 1 case was discharged automatically). In the subsequent follow-up, the recurrence of massive hemoptysis occurred in 3 cases within 1 ~ 3 months after operation, and angiography showed the presence of subclavian artery branch, esophageal proper artery, ectopic bronchial artery and original embolized vessel recalculation. Re-embolization was successful in hemostasis.Conclusion BAE and NBSAE embolization are effective in the treatment of massive hemoptysis. But the incomplete embolization,neglected the ectopic bronchial artery and abnormal systemic circulation vessels are ignored, and embolized vessels recalculation are the main cause of short-term bleeding.