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目的:评估支气管动脉栓塞术(BAE)对大咯血治疗的疗效,探讨BAE治疗大咯血的意义及对疗效的影响因素。方法:急症大咯血患者128例,均行动脉造影检查,明确出血血管,其中123例行BAE治疗,5例导管无法固定而放弃栓塞。结果:动脉造影共发现病变动脉265支,其中支气管动脉159支,非支气管动脉106支,123例患者栓塞后92例(74.8%)立即止血,14例(11.3%)有效,即时有效率86.2%,11例(8.5%)改善,6例(4.9%)无效;9例患者BAE0.5个月内复发出血者,再次造影发现1例原栓塞血管再通,8例发现新的出血动脉;11例患者在0.6～3个月内复发出血量>100ml/24h而再次造影发现3例原栓塞血管再通,5例侧支血管形成。结论:BAE可以有效的控制大咯血,达到较好的近期疗效,而远期疗效不稳定;在复发出血中,出血动脉的遗漏栓塞是引起早期复发出血的重要因素,而侧支循环的形成则是引起中远期复发出血的重要原因。
Objective: To evaluate the efficacy of bronchial artery embolization (BAE) in treatment of massive hemoptysis and to explore the significance of the treatment of massive hemoptysis by BAE and its influencing factors on the curative effect. Methods: One hundred and eighty-eight patients with acute hemoptysis underwent angiography. Hemorrhage was confirmed. One hundred and twenty-three patients underwent BAE. Five patients failed to fix the catheter and renounced the embolization. Results: A total of 265 arterial lesions were found in arterial angiography, including 159 bronchial arteries and 106 non-bronchial arteries. Of the 123 patients, 92 (74.8%) had hemostasis immediately after embolization and 14 (11.3%) were effective immediately after embolization. The immediate response rate was 86.2% , 11 cases (8.5%) were improved, 6 cases (4.9%) were ineffective; 9 cases of BAE within 0.5 months of recurrent bleeding, re-angiography found 1 case of primary embolization recanalization, 8 cases found new hemorrhage artery; Cases of patients with 0.6 to 3 months recurrence of bleeding> 100ml / 24h again angiography found 3 cases of primary embolization recanalization, 5 cases of collateral vessels. Conclusion: BAE can effectively control the hemoptysis and achieve better short-term curative effect, but the long-term curative effect is unstable. In the recurrent haemorrhage, the occlusion and embolization of the bleeding artery are the important factors that cause early recurrence of hemorrhage. The formation of collateral circulation Is caused by long-term recurrence of bleeding an important reason.