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目的:评价在变异支气管动脉的情况下,行超选择性插管栓塞治疗各种病因咯血的技术和价值。方法:在9例支气管动脉变异的肺癌、支气管扩张咯血患者中,右支气管动脉与第3、4、5右肋间动脉共干4例;左右支气管动脉共干1例;右下支气管动脉与左下支气管动脉共干2例;左支气管动脉由左第6肋间动脉约7 cm处呈“T”形垂直发出1例;右支气管动脉由右锁骨下动脉发出1例。采用Seldinger经皮穿刺技术插管,先送入5F或6F的型号的Cobra导管行支气管动脉造影,继选择微导管对病变供血的支气管动脉分支逐支行超选择性插管造影,采用明胶海绵颗粒+超液化碘油或/和PVA颗粒栓塞剂进行栓塞。结果:9例患者均插管成功,术后咯血停止及病情得到控制。无严重并发症发生。结论:应用微导管技术,行超选择性相关支气管动脉逐支插管,采用明胶海绵+超液化碘油和/或PVA的介入方法,对变异的支气管动脉介入治疗是安全有效的。
OBJECTIVE: To evaluate the technique and value of ultra-selective intubation embolization in the treatment of various causes of hemoptysis with variant bronchial arteries. Methods: In 9 patients with bronchial artery disease and bronchiectasis with hemoptysis, the right bronchial artery and the third, fourth and fifth intercostal arteries were co-rooted in 4 cases; left and right bronchial artery in 1 case; right bronchial artery and left lower Bronchial arteries were common in 2 cases; left bronchial artery in the left 6th intercostal artery about 7 cm at the T-shaped vertical issued 1 case; right bronchial artery issued by the right subclavian artery in 1 case. Seldinger percutaneous puncture technique intubation, first into the 5F or 6F model Cobra catheter bronchial artery angiography, following the choice of micro-catheter lesions of the bronchial artery branches by sub-branch super selective catheterization, the use of gelatin sponge particles + Ultra liquefied lipiodol or / and PVA particle embolization agent for embolization. Results: All the 9 patients were successfully intubated, the hemoptysis was stopped and the condition was controlled. No serious complications occurred. Conclusions: Micro catheter technique is a safe and effective method for the interventional treatment of variant bronchial artery with percutaneous catheterization of super selective selective bronchial artery with gelatin sponge and ultra liquefied lipiodol and / or PVA.