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目的探讨采用不同类型栓塞剂及栓塞方式栓塞支气管动脉-肺循环分流(BPS)的安全性及远期疗效。方法搜集129例大咯血患者中经DSA造影证实伴有BPS的89例为研究对象。89例中伴有原发病支气管扩张68例,肺结核13例,其他8例。术前均行支气管动脉CT成像(CTBA),依据CTBA行选择性支气管动脉造影。根据分流类型及分流量选用不同种类及规格的颗粒栓塞剂和(或)弹簧圈进行栓塞。其中,早期各型BPS丝线颗粒栓塞17例,早期中快速型BPS弹簧圈栓塞4例,后期各型BPS海绵颗粒栓塞19例,后期各型BPS PVA栓塞35例,后期分流量大伴快速型BPS弹簧圈+PVA栓塞9例,后期分流量大伴快速型BPS弹簧圈+海绵颗粒栓塞5例。术中严密观察血氧饱和度。栓塞成功标准:分流现象消失,靶血管闭塞。随访12~31个月。结果 89例中有56例非支气管体循环动脉(NBSA)参与供血,21例发现非支气管动脉-肺循环分流(NBSA-PS)。在DSA监视下均成功进行责任支气管动脉及NBSA栓塞治疗,术后即刻止血率100%,无脊髓损伤等严重并发症发生。随访中8例大咯血复发,复发时间1~15个月,发生率分别为丝线颗粒11.8%(2/17),海绵颗粒10.5%(2/19),弹簧圈100%(4/4)。结论支气管大咯血中各型BPS采用PVA颗粒或弹簧圈+PVA栓塞责任血管安全性高,远期止血疗效最优。
Objective To investigate the safety and long-term efficacy of embolization and embolization of bronchial artery and pulmonary circulation shunt (BPS) with different types of embolization agents. Methods A total of 89 patients with massive hemoptysis were enrolled in the study. Of the 89 patients, 68 cases were accompanied by primary bronchiectasis, 13 cases were pulmonary tuberculosis and 8 were other cases. Preoperative bronchial artery CT imaging (CTBA), according to the CTBA line selective bronchial artery angiography. According to the type of diversion and sub-flow rate of different types and sizes of particle embolization agent and (or) coil embolization. Among them, 17 cases of early BPS silk thread embolization, early fast BPS coil embolization in 4 cases, late BPS sponge particle embolization in 19 cases, late BPS PVA embolization in 35 cases, the latter part of the large flow with fast BPS spring Encapsulation + PVA embolism in 9 cases, large late with large BPS coil spring sponge embolization in 5 cases. Surgery closely observe the oxygen saturation. Successful embolization criteria: shunt disappeared, target vessel occlusion. Follow up for 12 to 31 months. Results In 89 cases, 56 non-bronchial artery (NBSA) was involved in blood supply and 21 non-bronchial artery-pulmonary circulation shunt (NBSA-PS) were found. Under the supervision of the DSA were responsible bronchial artery and NBSA embolization, the rate of hemostasis immediately after surgery 100%, no serious complications such as spinal cord injury. Follow-up in 8 cases of massive hemoptysis relapse, the recurrence time of 1 to 15 months, the incidence rates were 11.8% (2/17) of silk particles, sponge particles 10.5% (2/19), spring coil 100% (4/4). Conclusion The bronchial hemoptysis in various types of BPS using PVA particles or coil + PVA embolization responsibility of vascular safety, long-term hemostasis is the best.