支气管动脉栓塞术血管并发症的预防及治疗经验

目的:分析156例支气管动脉栓塞治疗咯血患者的临床资料,总结术后血管并发症发生的原因以及相应的预防、治疗方法。方法:1985年至2010年我科共完成156例支气管动脉栓塞治疗咯血病例。男性102例,女性54例,年龄12～79岁,平均46岁。其中支气管扩张114例,肺癌12例,匿源性咯血26例,其他疾病4例。患者均采用Seldinger法股动脉入路,行主动脉及支气管动脉造影,以医用明胶海绵、弹簧圈行栓塞治疗。术后严密监测相关血管并发症的发生情况。结果:156例患者中129例(94.9%)显示有支气管动脉异常改变。20例异常表现为支气管动脉与肺动脉间异常分流。所有异常血管分别栓塞。本组病例术后咯血症状缓解142例(91.1%),症状无改变10例(6.2%),死亡4例(2.0%)。术后出现下肢局部感觉障碍10例,腹痛症状12例,脊髓功能受损5例,支气管动脉破裂2例。经及时对症治疗及经验总结,后期发生率明显下降。结论:支气管动脉造影加栓塞是治疗咯血安全、有效的方法。合理的操作可以很好地减少术后血管相关并发症的发生,提高支气管动脉栓塞治疗的整体效果。

The experience of prevention and treatment for the vascular complication followed bronchial artery embolization

Objective:To analyse 156 patients with the treatment of bronchial artery embolization and summarize the preventive and therapeutic method for the postoperative vascular complication followed bronchial artery intervention.Methods:156 patients were performed bronchial artery embolization between 1985 and 2011 in our hospital.These patients included 102 males and 54 females.Mean age was 54years.114 cases were diagnosed bronchiectasis,26 cases were cryptogenic hemoptysis,12 cases were lung cancer.The occurrence of the postoperative vascular complication was monitored.Results:All patients received bronchial artery embolization.The objective response rate was 91.1%.mortality was 2.0%.the postoperative vascular complications were lower limb local sensory disturbance for 10 cases,abdominal pain for 12 cases and 5 cases with damage of spinal cord.Effective methods were done to decrease the incidence of the vascular complications.Conclusion:The accurate procedure of the bronchial artery embolization with the low incidence of the vascular complications is an effective method for the hemoptysis.