急性咯血的支气管动脉栓塞治疗

Treatment of acute hemoptysis by bronchial artery embolization

目的 探讨支气管动脉栓塞术 (BAE)治疗急性咯血的临床价值 ,观察不同栓塞物质及术式选择与栓塞效果及并发症的关系。方法 急性咯血病例 44例 ,2 6例行选择性支气管动脉栓塞 ,18例行超选择性支气管动脉病变区域分支栓塞 ;其中单纯明胶海绵栓塞 2 0例 ,长效栓塞物质栓塞 2 4例。全部病例随访 6～ 12个月 ,复发病例行再次栓塞。结果 44例中即刻止血 3 8例 (86.4%) ,出血明显减少 6例 (13 .6%)。复发 5例 (11.3 %) ,其中 4例为明胶海绵栓塞。术后 4例(9.1%)出现肋间动脉缺血和 /或一过性脊髓缺血 ,均为非超选择性栓塞组 ,组间结果差异无统计学意义。结论 BAE对急性咯血是一种安全高效的治疗手段 ;严格制定术式选择标准、合理采用栓塞技术和栓塞物质对减少复发和降低并发症意义重大。

Objective To study the clinical value of bronchial artery embolization in treatment of acute hemoptysis,and to observe healing effect and complications by different embolism technique and materials. Methods Bronchial artery embolization was performed in 44 cases with acute hemoptysis. Selective embolization was performed in 26 cases,and super-selective embolization in 18 cases. 20 cases were embolized with simple gelfoam particles and 24 cases with other agents. All patients were followed up for six to twelve months. Results Immediate and complete control was achieved in 38 cases (86.4%),marked reduce in bleeding showed in 6 cases (13.6%). Recurrence occurred in 5 cases (11.3%),4 of them were with simple gelfoam particles,and 1 together with other agents. Severe complications happened in 4 cases (9.1%),all with selective embolism technique. Conclusion Bronchial artery embolization (BAE) is a rather safe and effective method for treatment of acute hemoptysis,and strict standard,reasonable choice of embolism technique and embolism agents are very important in reducing recurrence and complications.