医用胶与栓塞微球介入栓塞治疗大咯血临床效果对比分析

Medical glue versus embolization microspheres for interventional embolization of massive hemoptysis:a comparative analysis of the clinical effects

目的对比分析医用胶栓塞与微球栓塞在大咯血患者血管介入治疗中的有效性和安全性。方法收集2019年5月至2023年4月因咯血收住于石河子大学第一附属医院、经内科药物治疗效果不佳并经医用胶与微球栓塞治疗的77例患者临床资料。其中医用胶组39例,微球组38例。对比分析两组患者止血疗效、不良反应、栓塞材料费用、血管栓塞成功率及复通情况。结果医用胶组、微球组术后止血疗效分别为显效27例(69.2%)、22例(57.9%),有效9例(23.1%)、10例(26.3%),无效3例(7.7%)、6例(15.8%),总有效率分别为92.3%、84.2%,差异无统计学意义(P=0.461);术后胸背痛分别为8例(20.5%)、3例(7.9%),胸闷分别为2例(5.1%)、4例(13.2%),皮下血肿分别为1例(2.6%)、0,失语分别为0、1例(2.6%),经对症处理后所有患者均缓解恢复,两组间不良反应差异无统计学意义(P=0.234);术中所用栓塞材料费用分别为(8605.7±4077.8)元、(10414.5±3571.2)元,差异有统计学意义(P=0.014)。医用胶组成功栓塞责任血管204支,技术成功率为100%,高于微球组90.8%(121/133),差异有统计学意义(P<0.01)。医用胶组复发咯血3例(7.7%),低于微球组11例(28.9%),差异有统计学意义(P<0.01)。医用胶组栓塞血管无复通,微球组复通率为9.1%(11/121),差异有统计学意义(P<0.01)。结论采用医用胶与微球栓塞治疗大咯血患者均安全有效。医用胶与微球相比血管栓塞成功率更高,咯血复发率、血管复通率、术中所用介入栓塞材料费用更低,在大咯血介入治疗中具有一定优势,值得临床推广应用。

Objective To compare the effectiveness and safety of medical glue and embolization microspheres in the vascular interventional treatment for patients with massive hemoptysis.Methods The clinical data of 77 patients with massive hemoptysis,who were admitted to the First Affiliated Hospital of Shihezi University of China between May 2019 and April 2023 to receive medical glue treatment or embolization microspheres treatment as the medication therapy was not effective,were retrospectively analyzed.According to the embolization materials used,the patients were divided into medical glue group(n=39)and microspheres group(n=38).The hemostatic efficacy,adverse reactions,cost of embolization materials,success rate of vascular embolization,and vascular recanalization were compared between the two groups.Results In the medical glue group and microspheres group,significant hemostatic effect was seen in 27 patients(69.2%)and 22 patients(57.9%)respectively,effective hemostatic effect in 9 patients(23.1%)and 10 patients(26.3%)respectively,and invalid hemostatic effect in 3 patients(7.7%)and 6 patients(15.8%)respectively;the total effective rate was 92.3%and 84.2%respectively,the difference was not statistically significant(P=0.461).In the medical glue group and microspheres group,postoperative chest and back pain was seen in 8 patients(20.5%)and 3 patients(7.9%)respectively,chest tightness in 2 patients(5.1%)and 4 patients(13.2%)respectively,subcutaneous hematoma in one patient(2.6%)and zero patient(0.0%)respectively,and aphasia in zero patient(0.0%)and one patient(2.6%)respectively;all the above symptoms were relieved after symptomatic treatment in all patients;no statistically significant difference in the incidence of adverse reactions existed between the two groups(P=0.234).The average cost of embolization materials used during operation in the medical glue group and microspheres group was(8605.7.3±4077.8)Chinese yuan and(10414.5±3571.2)Chinese yuan respectively,the difference was statistically significant(P=0.014).In medical glue group,a total of 204 responsible vessels were successfully obstructed,with a technical success rate of 100%,which was higher than 90.8%(121/133)in microspheres group,and the difference was statistically significant(P<0.01).The incidence of recurrent hemoptysis in medical glue group occurred was 7.7%(n=3),which was lower than 28.9%(n=11)in microspheres group,and the difference was statistically significant(P<0.01).In the medical glue group no recanalization of the embolized blood vessels was observed,while in the microspheres group the recanalization rate of the embolized blood vessels was 9.1%(11/121),and the difference was statistically significant(P<0.01).Conclusion For the treatment of patients with massive hemoptysis,interventional embolization therapy,regardless of using medical glue as embolization agent or using microspheres as embolization agent,is clinically safe and effective.Compared with the microspheres,the medical glue carries a higher success rate of vascular embolization,while its recurrence rate of hemoptysis,vascular recanalization rate and amount of embolization materials used during surgery are remarkably lower,which has certain advantages in the interventional therapy of massive hemoptysis,and it is worthy of clinical promotion and application.