支气管-肋间动脉联合栓塞治疗肺结核大咯血

目的探讨支气管-肋间动脉联合栓塞治疗肺结核大咯血的临床价值。方法19例肺结核大咯血患者,行选择性支气管动脉和肋间动脉造影并对病变血管用2 mm手术丝线段进行栓塞。结果19例咯血患者,共栓塞58支出血血管。其中行支气管动脉-肋间动脉联合栓塞17例,单独栓塞支气管动脉和肋间动脉各1例。17例联合栓塞患者24h内咯血停止16例,即刻止血率94.2%（16/17）;1周内咯血停止1例;近期有效率100%（17/17）。2例单独栓塞支气管动脉或肋间动脉者止血无效。36个月内复发2例。无严重栓塞相关并发症发生。结论支气管-肋间动脉联合栓塞是治疗肺结核大咯血的有效手段,具有止血迅速、复发率低及安全性高的优点。     

支气管-肋间动脉联合栓塞治疗肺结核大咯血

目的 探讨支气管-肋间动脉联合栓塞治疗肺结核大咯血的临床价值.方法 19例肺结核大咯血患者,行选择性支气管动脉和肋间动脉造影并对病变血管用2 mm手术丝线段进行栓塞.结果 19例咯血患者,共栓塞58支出血血管.其中行支气管动脉-肋间动脉联合栓塞17例,单独栓塞支气管动脉和肋间动脉各1例.17例联合栓塞患者24 h内咯血停止16例,即刻止血率94.2%（16/17）;1周内咯血停止1例;近期有效率100%（17/17）.2例单独栓塞支气管动脉或肋间动脉者止血无效.3～6个月内复发2例.无严重栓塞相关并发症发生.结论 支气管-肋间动脉联合栓塞是治疗肺结核大咯血的有效手段,具有止血迅速、复发率低及安全性高的优点.     

急性大咯血责任血管来源的DSA分析及临床栓塞治疗

目的回顾性分析急性大咯血责任血管的来源以及血管内栓塞治疗的有效性及安令性。方法对46例急性大咯血患者进行选择性支气管动脉及相关动脉造影,寻找到咯血的责任血管,对其用明胶海绵（GS）、海藻酸钠微球（KMG）、聚乙烯醇（PVA）、弹簧圈等材料进行栓塞。结果所有患者经动脉栓塞后全部即时止血,术后24h内无活动性出血41例,1例再次明显咯血经手术切除右上肺陈旧性病灶止血,4例少量咯血经内科保守治疗而止血。结论急性大咯血的责任血管来源较为复杂,除主要来源于支气管动脉外,还有相当的病例来源于其他动脉血管,如肋间动脉、隔下动脉、内乳动脉、腋动脉、甲颈干动脉等。急性大咯血血管内栓塞治疗是快速有效的、安全的。对急性大咯血内科治疗效果不佳而又无法耐受外科手术者,应及时行咯血责任血管造影和血管内栓塞治疗。     

介入治疗肺癌大咯血效果观察及注意事项探讨

目的观察介入治疗肺癌大咯血的临床效果及注意事项。方法 20例经内科保守治疗无效大咯血原发性肺癌患者,在数字减影血管造影（DSA）监视透视下采用Seld inger技术超选择支气管动脉造影,将明胶海绵颗粒＋造影剂（欧乃派克）在DSA监视下缓慢注入靶血管。结果 13例患者即刻止血,7例患者咯血明显减少,24 h咯血量〈50 m l,并在4~5天内停止咯血。8例患者在栓塞治疗后出现发热经对症治疗后在3~6 d后恢复正常;胸骨后疼痛10例,在3~10 d内缓解。结论介入治疗晚期肺癌大咯血疗效肯定,可列为治疗肺癌大咯血的首选手段。     

气管镜检查联合支气管动脉栓塞治疗良性大咯血

收集2016年1月至2019年9月在我科行支气管动脉栓塞治疗的咯血量>100 ml/24 h的中、大量咯血的107例患者（排除肿瘤性咯血）。107例患者支气管动脉栓塞显效率84.1%（90/107）,总有效率90.7%（97/107）。根据栓塞前完善CT血管造影（CTA）检查情况、有无气管镜检查,分为联合组68例（有气...     

支气管动脉栓塞治疗肺结核咯血的疗效分析

目的观察支气管动脉栓塞对治疗肺结核咯血的有效性及安全性。方法对37例咯血患者术前予支气管动脉血管CT成像（CTA）检查,大概明确出血部位,并行支气管动脉栓塞治疗。结果 37例患者行支气管动脉栓塞（BAE）后,治愈30例（81.1%）,显效4例（10.9%）,好转2例（5.4%）,无效1例（2.6%）。结论支气管动脉栓塞是治疗肺结核咯血的有效方法之一,选择性动脉栓塞治疗更安全,值得推广。咯血是肺结核的常见并发症,易引起病人窒息、死亡。有些患者内科治疗往往达不到立即止血的效果。目前我院支气管动脉栓塞治疗,以其显著的效果成为临床治疗咯血的有效方法之一。我院自2000年开展介入工作以来,共治疗肺部各种原因引起的咯血372例。其中肺结核咯血患者123例,绝大多数取得满意效果。本文就2008年1月～2009年12月本院肺结核咯血37例患者,用选择性支气管动脉栓塞术治疗的疗效进行分析。     

大咯血的急诊介入治疗

目的探讨支气管动脉栓塞治疗大咯血的适应症、并发症和疗效等。方法分析自2001年7月至2004年7月我院收治的急性大咯血患者63例。24小时咯血量为500-1550ml,平均610ml,以Seldinger技术穿刺右股动脉插管,再行患侧支气管动脉选择性插管,造影并栓塞出血血管。结果栓塞后,所有病例咯血量明显减少,24小时咯血量<50ml,并在3-5天内咯血停止,5例患者栓塞后1-2个月症状复发,行再次栓塞后未再咯血。全组无严重并发症。结论支气管动脉栓塞治疗大咯血安全有效。     

支气管动脉栓塞术后再咯血原因及治疗对策

目的探讨支气管动脉栓塞术（BAE）后再咯血的原因及相应的治疗对策。方法分析389例行支气管动脉栓塞术后发生再咯血的54例患者的咯血原因及治疗结果。结果54例再咯血中,34例为原有病变进展,占63．0％,DSA表现为出现新的出血灶和／或侧支循环形成。20例原因为原有病变血管再通,占37．0％。再次BAE术后治愈47例,占87．0％。结论支气管动脉栓塞术后应积极地治疗基础疾病防止原有病变进展。在支气管动脉栓塞术操作过程中防止漏栓供血动脉,并注意操作技巧,选择适当的栓塞材料。     

超选择性支气管动脉栓塞术治疗肺结核大咯血的护理

咯血是临床常见的急诊之一,肺结核是咯血的常见病因之一[1].支气管动脉栓塞术已成为临床治疗大咯血（一次咯血量〉100 ml或24 h咯血量〉500 ml）的有效方法,近年来已有较多文献报道,该方法对大咯血的治疗有效率达80%左右[2].2005～2009年,我院采用超选择性支气管动脉栓塞术治疗肺结核大咯血患者48例,取得满意疗效,现将护理体会报告如下.     

介入治疗大咯血的支气管造影与栓塞

目的讨论介入治疗的支气管造影与栓塞对不同的肺部疾病所引起的大咯血的应用价值。方法所有59例病人均采用SELDINGER技术经股动脉穿刺插管行数字减影血管造影（DSA），明确病变部位或出血动脉后，采用永久性栓塞剂灭菌真丝线段或／和金属钢圈，经支气管动脉或／和肋间动脉行拴塞术。结果59例病人有31例咯血立即停止，即时止血率达52．5％，21例咯血在1周内渐止，4例病人咯血次数及咯血量均有不同程度的减少，介入治疗近期有效率达88．14％（52／59）。在1～4年的随访中，良恶性病变3个月内复发率分别为6．45％（2／31）、42．86％（12／28），1年内复发率分别为78．57％（22／28），9．68％（3／31）。结论介入治疗对肺部大咯血近期疗效确切，但远期疗效与疾病的性质，血供情况，病灶大小及栓塞剂的选用密切相关。     

Use of endoscopic fibrinogen-thrombin in the treatment of severe hemoptysis

Bronchial artery embolization (BAE) is the treatment of choice in the majority of patients with severe hemoptysis. However, this procedure may be unavailable and even fail or be counterindicated in 4-13% of cases. In these cases, the efficacy of fibrinogen-thrombin (FT) instilled endoscopically as treatment for massive hemoptysis was assessed. Between August 1993 and February 1996 a prospective clinical study was performed. FT instillation was indicated in all patients with severe hemoptysis (> 150 ml/12 h) in whom BAE had failed, was counterindicated or not available. FT was instilled endoscopically. Patients were followed up until June 2001. Eleven of 101 patients (11%) with hemoptysis > 150 ml/12 h in whom BAE was not possible or proved ineffective were included. The severe hemoptysis was controlled immediately in all cases. During the follow-up period (mean: 39.4 months), early relapse of the severe hemoptysis occurred in two patients (18%) and a long-time relapse in one. Mean procedure duration was 3 min and no attributable complications were observed in any case. In conclusion, these results suggest that topical treatment with FT could be considered in the initial endoscopic evaluation of patients with severe hemoptysis while awaiting BAE or surgery, or as alternative treatment to arterial embolization when the latter is not available, has proved ineffective or is counterindicated.     

介入栓塞治疗肺动脉假性动脉瘤伴大咯血的临床疗效分析

目的 探讨体肺双途径栓塞治疗肺动脉假性动脉瘤(pulmonary artery pseudoaneurysms,PAPs)伴大咯血的临床疗效及安全性.方法 回顾性分析2016年1月至2018年2月海南医学院第二附属医院收治的经CT血管造影(CT angiography,CTA)/数字减影血管造影(digital subtractive angiography,DSA)证实为PAPs伴大咯血的15例肺结核患者的临床资料.记录相关影像学表现、介入治疗技术和临床止血成功情况,随访1年内咯血复发状况.结果 共发现15个PAPs,肺CTA发现14个,血管造影发现1个.术中仅支气管动脉造影发现6个,仅肺动脉造影发现4个,支气管动脉及肺动脉造影均发现4个,1个体肺动脉造影均未发现.介入栓塞术后咯血有效止血14例,1例患者术中因大咯血窒息导致死亡.患者随访12个月,其中1例患者术后2周复发大咯血行外科切除术;1例咯血术后3个月余复发,再次行介入栓塞后咯血停止.结论 经体肺双途径栓塞治疗肺结核患者PAPs伴大咯血的临床疗效确切,方法可行,但仍有一定风险.     

Severe hemoptysis of pulmonary arterial origin: signs and role of multidetector row CT angiography

BACKGROUND: Hemoptysis of pulmonary arterial origin is a diagnostic challenge in patients admitted to a respiratory ICU (RICU) for treatment of hemoptysis. Its early accurate recognition and treatment reduce morbidity and prevent mortality. Multidetector row CT angiography (MDCTA) is an accurate method for imaging the systemic vascular network. Our aim was to assess the MDCTA signs and role in managing hemoptysis of pulmonary arterial origin. METHODS: We performed a retrospective clinical and radiologic analysis of all consecutive patients who were referred for severe hemoptysis to our RICU and were treated by endovascular means between January 2004 and December 2006. We reviewed all of those cases with hemoptysis of pulmonary arterial origin. RESULTS: Of 272 patients who were referred for severe hemoptysis to the RICU, 189 patients were treated by endovascular means. Thirteen patients (nine men, four women; mean age, 45 years) had hemoptysis of pulmonary arterial origin. Signs of pulmonary arterial hemoptysis seen on MDCTA were of the following three types: pseudoaneurysm (n = 5); aneurysm of the pulmonary artery (n = 3); or the presence of a pulmonary artery in the inner wall of a cavity (n = 5). Hypertrophy of the bronchial arteries seen on MDCTA associated with any of these signs predicted the necessity to treat both the bronchial and pulmonary arteries. Pulmonary artery vasoocclusion was performed as a first treatment in eight patients with such an association (n = 1) or without such an association (n = 7) along with bronchial artery embolization. The remaining five patients were treated with systemic artery embolization, followed by surgery (n = 1), pulmonary artery vasoocclusion (n = 3), and death from massive hemoptysis (n = 1). CONCLUSIONS: MDCTA performed prior to endovascular treatment allows the correct identification and early appropriate management of severe hemoptysis of pulmonary arterial origin.     

支气管动脉栓塞术治疗大咯血的疗效观察

目的 探讨支气管动脉栓塞治疗大咯血的长期疗效、安全性及并发症.方法 回顾分析天津市海河医院2000年2月至2009年2月间因大咯血行支气管动脉栓塞术的232例患者病例资料,其中男122例,女110例,年龄21～85岁,中位年龄52岁.患者均于术后24 h开始进行术后观察及持续随访,回访患者复杳X线胸片或胸部CT,并进行电话或问卷回访,最短2个月,最长9年.结果 232例患者共栓塞血管627支,使用弹簧圈741枚,所有患者均即刻止血(232/232,100%),一次栓塞治愈213例(213/232,91.8%),好转19例(19/232,8.2%),术中无死亡病例,未发生严重并发症及远期不良事件.结论 支气管动脉栓塞术治疗咯血安全有效,即刻止血率高,严重并发症及远期不良事件较少.     

Idiopathic hemoptysis in pregnant women: A distinct entity?

In pregnant women, the reported cases of hemoptysis were most often mild and had an identified cause. Between November 2003 and January 2006, three pregnant women at 16-20 weeks gestation were admitted to our respiratory intensive care unit for massive hemoptysis. One of the women had experienced mild hemoptysis, considered as idiopathic, during her first pregnancy, with no recurrence until her second pregnancy. In all three cases, hemoptysis was massive. CT scan after iodine injection did not reveal any cause. Opacification of the bronchial artery showed hyperemia from abnormally dilated and tortuous bronchial arteries. Bronchial artery embolization (BAE) was performed in all three patients, successfully in two. Intravenous vasopressin was used as second-line treatment for recurrent bleeding after BAE in one patient. The women carried the pregnancy to term with delivery of healthy infants. Further complete investigation after the births did not identify any possible local (pulmonary) or general cause of bleeding in these three patients. Although these cases could be considered idiopathic, the close association with duration of pregnancy suggests the hemoptysis may be related to hormonal changes.     

超选择性支气管动脉栓塞术治疗大咯血的临床效果分析

目的探讨超选择性支气管动脉栓塞术治疗大咯血的临床价值。方法 52例大咯血患者经支气管动脉造影明确岀血动脉后行支气管动脉栓塞术,采用明胶海绵颗粒、明胶海绵条或联合弹簧钢圈进行栓塞。所有患者随访3～12月,观察栓塞术后有无再次岀血及并发症的发生。结果 52例患者均顺利完成支气管动脉栓塞术,于一周内咯血症状逐渐消失,其中6例患者分别于术后6月～10月后咯血复发,再次行性支气管动脉栓塞术咯血消失。无严重栓塞术后并发症发生。结论超选择性支气管动脉栓塞术是治疗大咯血安全、有效的治疗方法。     

Refractory Hemoptysis Caused by Severe Pulmonary Vein Stenosis after Multiple Catheter Ablations

We herein report a 48-year-old man with a history of chronic atrial fibrillation (AF) and repeated hemoptysis after radiofrequency ablation. Contrast tomography showed soft tissue thickening of the left hilar region and left pulmonary vein stenosis. We performed bronchial artery embolization, but the hemoptysis did not disappear, and AF was not controlled. We performed left lung lobectomy and maze procedures since we considered surgical removal necessary as radical treatment. After the surgery, hemoptysis and atrial fibrillation did not recur. Refractory hemoptysis after catheter ablation is rare, but occasionally occurs in patients with severe pulmonary vein stenosis.     

Glubran2胶介入栓塞在肺癌咯血中的应用效果

目的探讨Glubran2胶介入栓塞在肺癌咯血中的应用效果。方法回顾性分析山东省新汶矿业集团莱芜中心医院2009—2012年期间采取姑息治疗的30例中晚期肺癌咯血患者的临床资料,均行Glubran2胶介入栓塞治疗。结果栓塞完成即刻造影,支气管动脉为其靶动脉,均于术中成功注胶,Glubran2胶血管内铸型良好。即刻止血23例,术后4 h止血7例。术后复发1例,无一例出现脊髓损伤、窒息等严重并发症。术后6、12及24个月随诊无咯血事件。结论 Glubran2胶介入栓塞治疗肺癌咯血创伤小、安全、止血率高、复发率低。     

支气管动脉造影对隐源性大咯血手术治疗的定位作用

本文分析1985～1991年136例大咯血支气管动脉造影（BAG）所见，在病变及出血部位大部分能见到局限性的异常支气管动脉（BA），其出现率及严重程度明显高于无病变及非出血区。136例中45例为隐源性出血，虽胸片等所见阴性，86．7％的病例BAG中出现BA不正常。说明隐源性大咯血可经BAG确定出血部位，使肺切除治疗成为可能。     

Percutaneous bronchial artery embolization in the management of massive hemoptysis in chronic lung diseases. Immediate and long-term outcomes

AIM: Bronchial artery embolization (BAE) is a well-established, non-surgical procedure in the emergency treatment of massive hemoptysis. This study aims to evaluate the immediate and long-term prognosis of BAE for the management of massive hemoptysis in our center. METHODS: Twenty consecutive patients (mean age: 59+/-14 years) with massive hemoptysis, underwent BAE with microspheres (Embospheres BioSphere Medical SA, Paris, France), polyvinyl alcohol particles (PVA, Ivalon, Cathmed Science; Paris, France) or/and steel coils (Cook, Denmark) after thoracic aortography and diagnostic selective and superselective catheterization of bronchial arteries and systemic collateral vessels in the bleeding lung area. Hemoptysis was due to bronchiectasis (55%), non-operable aspergillomas (15%), active tuberculosis (15%), malignancy (10%) and cystic fibrosis (5%). Mean duration of follow-up was 29+/-18 months. The recurrent-free time was calculated with Kaplan-Meier analysis. RESULTS: Immediate control of bleeding was achieved in all patients. Recurrent cases of hemoptysis were observed in 6/20 patients (30%) within 3 years and 4 of them (66.6%) occurred early in the first 3 months. Recurrent-free time was 9 months (standard error: 4) (95% confidence interval: 0-17). Repeated interventions were required in all early recurrences, due to either recanalization of the occluded arteries or non-bronchial systemic artery supply. Combined use of PVA and coils was proved effective in these cases. No serious complications were observed. CONCLUSION: BAE is an effective and safe intervention in cases of massive hemoptysis. However, recurrences are common and long-term follow-up is considered important with a view to perform repeated interventions with combination of embolic materials.