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目的探讨支气管动脉栓塞术治疗大咯血的临床疗效及安全性。方法42例大咯血患者,男26例,女16例,年龄26～75岁,平均48.5岁,咯血病史3d～28年,其中支气管扩张症30例,肺结核8例,肺癌2例,原因不明咯血2例,全部病例经选择性支气管动脉及相关肺外体循环动脉造影诊断,明确出血部位及范围,了解病变部位的血管形态特点,酌情选择栓塞剂进行栓塞,造影复查,至病变区域血管闭塞无造影剂外溢则停止栓塞。结果41例大咯血均于栓塞术后即刻止血,其中37例随访6个月～7年未见复发,1例有严重B-P分流及肺外体循环参与出血的肺结核患者,栓塞术后24h内再次出现大咯血,虽经5次动脉栓塞,,终因咯血不止而死亡(4.76%)。42例均无严重并发症。结论支气管动脉栓塞术治疗大咯血是行之效的方法,但栓塞剂的合理选择及积极寻找发现参与出血的肺外体循环并适当处理是保证疗效减少复发的关键。
Objective To investigate the clinical efficacy and safety of bronchial artery embolization in treating massive hemoptysis. Methods Forty-two patients with massive hemoptysis, including 26 males and 16 females, aged from 26 to 75 years, with an average age of 48.5 years and a history of hemoptysis from 3 to 28 years. Among them, 30 cases were bronchiectasis, 8 cases were pulmonary tuberculosis and 2 cases were lung cancer. 2 cases, all cases of selective bronchial artery and pulmonary extracorporeal arterial angiography diagnosis, clear bleeding location and range, to understand the characteristics of the lesion vascular morphology, as appropriate, embolization embolization, angiography review, to the lesion area without vascular occlusion Excretion stopped bleeding. Results 41 cases of massive hemoptysis were hemostat immediately after embolization, of which 37 cases were followed up for 6 months to 7 years, no recurrence, one case of severe BP shunt and pulmonary extracorporeal circulation in patients with pulmonary tuberculosis, reappearance within 24h after embolization Hemoptysis, although after 5 arterial embolisms, died of more than hemoptysis (4.76%). 42 cases were no serious complications. Conclusions Bronchial artery embolization is effective in treating massive hemoptysis. However, the rational choice of embolic agent and the active search for the extrahepatic body circulation involved in hemorrhage and appropriate treatment are the keys to ensure the curative effect of reducing recurrence.