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目的探讨咯血病灶的多支血供特点,以及应用明胶海绵栓塞供血动脉治疗顽固性咯血的临床价值。方法128例内科治疗无效的咯血患者,包括支气管扩张70例,肺结核23例,肺癌27例,肺隔离症2例,真菌感染2例,外伤1例,胸部术后3例。采用Seldinger技术行股动脉穿刺,将导管插至胸主动脉和锁骨下动脉,探查病灶供血动脉,并行数字减影血管造影(DSA)。针对供血动脉用明胶海绵进行栓塞。所有病例均随访6月以上。将具有2支或2支以上病灶供血动脉的病例作为统计对象。结果89例存在病灶多支血供,占69.5%(89/128),总共233支多支供血动脉中包括支气管动脉157支,肋间动脉54支,胸廓内动脉18支,甲状颈干2支,迷走供血动脉2支。上述动脉呈不同程度增粗。除2例支气管扩张和1例肺癌外,其余86例栓塞后咯血症状改善,有效率96.6%(86/89),其中15例复发,复发率为17.4%(15/86)。无严重的栓塞后并发症出现。结论部分咯血患者的病灶具有多支动脉供血,栓塞前全面探查病灶供血动脉是必要的;针对病灶的多支供血动脉栓塞是治疗顽固性咯血的一种安全、有效的方法。
Objective To investigate the characteristics of multiple blood supply of hemoptysis and the clinical value of using gelatin sponge to embolize the feeding artery for the treatment of intractable hemoptysis. Methods A total of 128 patients with hemoptysis with ineffective medical treatment included bronchiectasis, 23 cases of pulmonary tuberculosis, 27 cases of lung cancer, 2 cases of pulmonary sequestration, 2 cases of fungal infection, 1 case of trauma and 3 cases of thoracic surgery. Seldinger technique was used to perform femoral artery puncture. The catheter was inserted into the thoracic and subclavian arteries, the diseased donor artery was dissected, and digital subtraction angiography (DSA) was performed. Embolization of the feeding artery with gelatin sponge. All cases were followed up for more than 6 months. The cases with 2 or more lesion feeding arteries were taken as statistical objects. Results There were 89 cases (89.5%) of the 89 cases (89/128 cases) with a total of 233 cases. A total of 233 multiarterial arteries included 157 bronchial arteries, 54 intercostal arteries, 18 internal thoracic arteries, 2 , Vagus artery 2. The arteries showed varying degrees of thickening. Except for 2 cases of bronchiectasis and 1 case of lung cancer, the remaining 86 cases showed improvement of hemoptysis after the embolization, with an effective rate of 96.6% (86/89), of which 15 cases relapsed with a recurrence rate of 17.4% (15/86). No serious complications after embolism. Conclusion It is necessary to provide multiple branches of artery for hemoptysis in patients with partial hemoptysis. It is necessary to probe the lesion donor artery thoroughly before embolization. Multi-artery arterial embolization for lesions is a safe and effective method for the treatment of intractable hemoptysis.