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目的探讨隐源性咯血的病因、血供来源及血管内栓塞治疗效果。方法搜集大咯血患者13例,术前均经CT和/或支气管镜检查证实肺内无原发病灶。结合CT支气管动脉血管成像(CTBA)明确责任血管,所有患者均成功插管并进行支气管动脉数字减影血管造影(DSA),对责任血管进行栓塞治疗。术后观察止血效果并进行随访。结果 DSA发现支气管动脉共31支,右肺17支,左肺14支。DSA表现为支气管动脉主干增粗,末梢血管网增生,未见明显对比剂外溢征象,2例伴肺动脉分流。支气管动脉增粗(主干≥2 mm)25支,正常(主干<2 mm)6支。栓塞后所有患者即刻咯血停止,血痰颜色由鲜红逐渐转为黑褐色。1例复发。结论隐源性咯血的病变血管源于支气管动脉,与长期吸烟及慢性阻塞性肺疾病有关,血管内介入栓塞安全有效。
Objective To investigate the etiology, blood supply and endovascular embolization of cryptogenic hemoptysis. Methods Thirteen patients with hemoptysis were collected and confirmed by CT and / or bronchoscopy before operation. Combined with CT bronchial arterial angiography (CTBA), we determined the responsible vessels. All patients were successfully intubated and performed digital subtraction angiography (DSA) of bronchial artery to embolize the responsible vessels. Postoperative hemostatic effect was observed and followed up. Results DSA found a total of 31 bronchial arteries, 17 right lungs and 14 left lungs. DSA manifested bronchial artery thickening of the main artery, vascular network hyperplasia, no obvious contrast agent spill signs, 2 cases with pulmonary artery shunt. Bronchial artery thickening (trunk ≥ 2 mm) 25, normal (trunk <2 mm) 6. Immediately after embolization, all patients stopped immediately hemoptysis, bloody sputum color gradually changed from bright red to dark brown. 1 case of recurrence. Conclusions The blood vessels of cryptogenic hemoptysis are originated from the bronchial artery, which is related to long-term smoking and chronic obstructive pulmonary disease. Endovascular embolization is safe and effective.