肺血管畸形大咯血的急诊动脉栓塞治疗

Emergency transcatheter arterial embolization therapy for massive hemoptysis caused by pulmonary-vascular abnormalities

目的探讨肺血管畸形大咯血患者的血管造影表现及急诊动脉栓塞治疗(emergency transcatheter arterial embolization,ETAE)的疗效。方法 38例肺血管畸形大咯血患者采用急诊介入造影检查,明确出血部位后,采用丙烯酸微球(tricacryl gelatin microphere,TAGM)和明胶海绵条对出血动脉行急诊栓塞治疗,对动脉造影表现及治疗结果进行回顾性分析。结果 38例患者共找到并成功栓塞52支出血动脉。22例诊断为支气管动脉-肺动脉瘘;8例为肋间动脉—肺动脉瘘;4例患者为甲状颈干—肺动脉瘘;支气管动脉—肺静脉瘘及肋间动脉—肺静脉瘘各2例。7例患者栓塞止血后择期行患侧肺叶手术切除。栓塞术后随访12个月,所有栓塞治疗后的患者均无复发咯血。结论 ETAE治疗肺血管畸形大咯血是一种创伤小、安全、疗效确切的治疗手段。认识咯血病变血管的多源性和供血方式的复杂性是治疗成功的前提,对所有供血动脉的彻底栓塞是治疗成功的关键。

Objective To explore the curative effect of emergency transcatheter arterial embolization(ETAE)in patients with massive hemoptysis caused by pulmonary-vascular abnormalities.Methods 38 cases of massive hemoptysis caused by pulmonary-vascular abnormalities underwent emergency arteriography.After bleeding arteries were located,the patients were given embolotherapy with tricacryl gelatin microphere(TAGM)and gelfoam strips.The arteriography manifestations and therapeutic outcome of all 38 patients were retrospectively analysed.Results 52 bleeding arteries were located and embolized successfully in 38 patients.22patients were diagnosed with bronchial artery-pulmonary artery fistul;8patients were diagnosed with intercostal artery-pulmonary artery fistul;4patients were diagnosed with thyrocervical trunkpulmonary artery fistul;Bronchial artery-pulmonary vein fistul and intercostal artery-pulmonary vein fistul were diagnosed both two case.Pulmonary lobectomy was performed in 7patients after hemostasis of embolotherapy.After 12-month follow-up,all patients had no recurrence haemoptysis after the embolotherapy.Conclusion ETAE is a small trauma,safety and efficacy treatment for the massive hemoptysis caused by pulmonary-vascular abnormalities.The precondition of successful treatment is to know the polyphyly of haemoptysis disease blood vessels and the complexity of blood supply.The key of successful treatment is to completely embolize all blood supply arteries.