经导管支气管动脉栓塞术治疗咯血术后复发的原因及预防

目的探讨咯血患者经导管支气管动脉栓塞术(BAE)治疗后出血复发的原因及预防措施。方法对85例咯血患者行选择性或超选择性BAE治疗,以明胶海绵(GS)颗粒和(或)GS条栓塞37例,PVA微粒联合GS(PVA+GS)条多重栓塞48例。所有病例随访6～18个月,对复发病例复查造影明确原因后进行第二次栓塞。结果咯血复发17例,复发率20.00%。其中GS栓塞复发13例,复发率35.14%(13/37),原因为栓塞血管再通(8例),肺内病变供血血管漏栓(2例),肺外体循环动脉供血漏栓(1例)和病变侧支循环形成(2例);PVA+GS栓塞复发4例,复发率8.33%(4/48),原因包括基础疾病进展新生血管形成(3例)和病变侧支循环形成(1例)。结论咯血患者BAE治疗后复发出血与栓塞剂的选择、栓塞技术及基础疾病有关。采用多重栓塞技术、合理选择栓塞剂及积极治疗基础疾病能有效降低咯血复发率。     

急诊经导管支气管动脉栓塞术治疗支气管动脉-肺动脉瘘大咯血

目的探讨急诊经导管支气管动脉栓塞(BAE)治疗支气管动脉-肺动脉瘘大咯血的疗效。方法回顾性分析17例支气管动脉-肺动脉瘘大咯血患者动脉造影表现及急诊BAE的疗效。经急诊动脉造影明确出血部位后,采用聚乙烯醇(PVA)颗粒和明胶海绵条对出血动脉行BAE;术后评价疗效、并发症及咯血复发情况。结果 17例中共发现29支病变支气管动脉,成功予以栓塞。BAE术后16例24h内完全停止咯血,1例于术后2天完全停止咯血。5例于BAE后接受外科手术,切除原发病灶。BAE后未发生严重并发症,随访2年,咯血均无复发。结论急诊BAE治疗支气管动脉-肺动脉瘘大咯血安全、有效。     

采用不同栓塞材料的支气管动脉栓塞术治疗大咯血的疗效分析

目的探讨在支气管动脉栓塞术（BAE）中采用不同栓塞材料治疗大咯血的临床疗效。方法对59例内科治疗无效的大咯血患者,于术前常规CTA后行BAE;对其中18例单纯应用明胶海绵（GS组）,41例应用海藻酸钠微球（KMG）联合GS或弹簧圈（KMG组）进行栓塞。所有病例随访12个月以上,并对疗效进行对比分析。结果对所有患者均成功实施BAE。58例患者BAE术后24h内停止咯血,有效率98.31%（58/59）。12个月内9例复发咯血（GS组6例,KMG组3例）,总复发率15.25%（9/59）。术后3个月内两组各2例患者复发咯血,复发率差异无统计学意义;术后3～12个月KMG组复发率（1/41,2.44%）低于GS组（4/18,22.22%,P=0.03）。结论 BAE术中合理选择栓塞材料可有效降低术后大咯血的复发率。     

浅谈支气管动脉栓塞(BAE)治疗大咯血的临床应用价值

目的:通过对100例支气管动脉拴塞(BAE)治疗大咯血回顾性分析,探讨其临床应用的价值.方法:急诊DSA下行支气管动脉栓塞(BAE)治疗大咯血100例.结果:本组当即见效86例;11例术后3-10天复发,再次(BAE)治疗后临床咯血症状消失;3例栓塞失败,1例支气管动脉找不到,其中2例患者病情突然加重,放弃栓塞;本组总有效率为97%.结论:(BAE)方法治疗大咯血,创伤小、效果好、成功率高、并发症少、死亡率低.     

Viatorr支架用于TIPS治疗原发性肝癌合并肝硬化上消化道出血

目的 观察Viatorr支架用于TIPS治疗原发性肝癌(PHC)合并肝硬化上消化道出血的安全性及有效性。方法 回顾性分析20例PHC合并肝硬化上消化道出血患者,均以Viatorr支架行TIPS,记录TIPS技术成功率、临床成功率、并发症及上消化道出血有无复发,以及TIPS后1、3、6及12个月分流道是否通畅。结果 20例TIPS均成功,技术成功率100%;TIPS前、后门静脉压分别为(37.58±7.26)mmHg及(18.35±6.47)mmHg,差异有统计学意义(P<0.05)。TIPS后72 h内均无活动性出血或血红蛋白下降,临床成功率100%(20/20)。围手术期未见腹腔出血、肝癌破裂出血及胆汁漏等严重并发症。随访期间4例(4/20,20.00%)发生肝性脑病,经对症治疗后均好转;2例(2/20,10.00%)复发上消化道出血;6例(6/20,30.00%)死亡;TIPS后1、3、6及12个月分流道通畅率分别为100%(20/20)、100%(20/20)、100%(20/20)及95.00%(19/20)。结论 Viatorr支架用于TIPS治疗PHC合并肝硬化、上消化道出血安全、有效。     

MRI所见透明质酸相关眼动脉栓塞患者视神经表现与经导管眼动脉溶栓疗效的关系

目的 观察MRI所见透明质酸（HA）面部美容填充相关眼动脉栓塞患者视神经表现与经导管眼动脉溶栓疗效的关系。方法 回顾性分析60例HA相关眼动脉栓塞患者，根据视神经于弥散加权成像中可见高信号灶与否将其分为阳性组（n=39）和阴性组（n=21）；于经导管眼动脉溶栓治疗后随访3个月，评价治疗效果及其影响因素。结果 对60例均成功完成经导管眼动脉溶栓，19例治疗有效（含阳性组4例、阴性组15例）、41例无效（含阳性组35例、阴性组6例），阴性组疗效优于阳性组（P＜0.01）。以25.5 h为中位时间间隔节点，介入治疗效果在间隔≤25.5 h（8例有效、22例无效）与＞25.5 h患者（11例有效、19例无效）之间差异无统计学意义（P=0.58）。结论 经导管眼动脉溶栓用于治疗MRI显示存在视神经缺血性损伤表现的HA面部美容填充相关眼动脉栓塞患者往往效果有限。     

导管接触性溶栓治疗急性上肢动脉栓塞

目的 观察导管接触性溶栓治疗急性上肢动脉栓塞（AUEAE）的临床效果。方法 对18例（18肢）AUEAE行导管接触性溶栓治疗,术后规律抗凝,观察治疗效果及并发症。结果 18例导管接触性溶栓治疗均获成功,技术成功率为100%（18/18）。经溶栓治疗后症状及体征均有所改善,其中痊愈83.33%（15/18）,良好11.11%（2/18）,一般5.56%（1/18）;导管接触性溶栓时间36~84 h,平均（58.83±12.28）h。抗凝治疗过程中1例血小板减少超过50%;术后3例出现穿刺点血肿,1例出现穿刺点股动脉假性动脉瘤,1例出现肾功能损伤;经相应处理后缓解或治愈。结论 导管接触性溶栓治疗AUEAE的近期有效性及安全性均较好。     

栓塞治疗顽固性咯血患者支气管动脉-肺动脉瘘

目的观察顽固性咯血患者的支气管动脉-肺动脉瘘(BPF)血管造影征象,探讨对不同类型BPF患者采用聚乙烯醇(PVA)颗粒和明胶海绵条行支气管动脉栓塞(BAE)的安全性及疗效。方法回顾性分析15例接受BAE治疗且存在BPF的顽固性咯血患者资料。均采用Seldinger法股动脉穿刺入路,行主动脉及支气管动脉造影,观察BPF的表现,采用医用PVA颗粒、明胶海绵条行栓塞治疗。术后严密监测并发症的发生,评价BAE术后疗效及随访咯血复发情况。结果对15例患者均采用PVA颗粒栓塞瘘口、病变区末梢供血动脉,明胶海绵条栓塞支气管动脉主干,BAE治疗成功率为100%(15/15),共成功栓塞21支病变动脉,影像学表现为瀑布型3支,枯枝型6支,斑片型12支。无异位栓塞、感染等严重并发症发生。治疗后随访1~3年,1年内3例复发,其中2例为肺癌患者,再次栓塞新病灶区后咯血停止,分别于15、17个月后死亡;另1例为肺结核患者,为痰中少量带血,经临床对症止血治疗一周后出院,未再发生咯血症状。结论支气管动脉-肺动脉瘘血管造影表现形式多样,采用PVA颗粒和明胶海绵条的栓塞均安全、有效。     

经导管动脉栓塞治疗局部晚期乳腺癌伴皮肤破溃

目的 观察经导管动脉栓塞（TAE）用于改善经常规化学治疗（化疗）无效的局部晚期乳腺癌伴皮肤破溃的效果。方法 10例晚期乳腺癌经常规化疗及系统靶向治疗均无效,肿瘤增大伴皮肤破溃,伴恶臭、渗液、出血及感染等;于DSA引导下对其行TAE栓塞肿瘤供血动脉,术后观察症状改善情况。结果 10例均成功栓塞肿瘤供血动脉,技术成功率100%;术后均未出现栓塞相关皮肤坏死及神经损伤。术后7天皮肤症状均明显改善;术后30天9例皮肤破损面积减小、1例皮肤破溃加重;术后2个月内6例、术后3个月内10例皮肤破损面积增大并症状复发。结论 TAE用于治疗伴皮肤破溃的局部晚期乳腺癌能在短期内显著改善症状,但中长期效果有限。     

Glubran-2胶用于栓塞治疗硬脊膜动静脉瘘

目的 观察以Glubran-2胶栓塞治疗硬脊膜动静脉瘘(SDAVF)的效果。方法 回顾性分析19例接受Glubran-2胶栓塞治疗的SDAVF患者,观察治疗后即刻栓塞效果、3个月后MRI表现、6个月后数字减影血管造影(DSA)表现及改良Aminoff-Logue评分,并根据后者评估疗效为稳定、改善或加重。结果 治疗后即刻造影示19例瘘口均完全封闭。治疗后1个月1例再次出现下肢无力和排尿困难,脊髓血管造影示瘘口复发,转外科治疗后病情稳定;治疗后3个月复查MRI示18例脊髓水肿范围均较治疗前明显缩小、血管流空影消失;治疗后6个月复查脊髓动脉DSA,18例均未见瘘口复发;改良Aminoff-Logue评分4.5(1.8,8.0),与治疗前[7.5(3.8,9.0)]差异有统计学意义(Z=－3.16,P<0.05),评定疗效为4例稳定、13例改善及1例加重。随访期间未见严重并发症。结论 Glubran-2胶用于栓塞治疗SDAVF效果较好。     

Post covid-19 invasive pulmonary Aspergillosis: A case report

Introduction and importanceSeveral complications after corona viral infection-19 (COVID-19) have been reported. The study aims is to present a case with post-covid-19 pulmonary fungal infection with antifungal resistance characteristics.Case presentationA 50-year-old male presented with hemoptysis, dyspnea, cough, fever, and rigor for 4-month duration. Three weeks before this complaint, he had cured of COVID-19. Investigations showed multiple ill-defined cavitary lesions involving the left upper lobe. The patient underwent a left upper lobectomy. The post-operative period was uneventful.Clinical discussionAll studies of COVID-19 fungal infections reported occurrence during the COVID-19 infection, mostly 14 days after the appearance of COVID-19 symptoms. The case in the current study was a 50-year-old patient, who was previously diagnosed with COVID-19 for a period of 4 months. After a few days from his recovery, the patient developed dyspnea, cough, fever, and rigor again.ConclusionPulmonary aspergillosis is a serious complication of COVID-19 patients that may not respond well to medical therapy. Pulmonary resection is the last and effective strategy to control the disease.     

不明原因咯血的临床特点及治疗

目的探讨不明原因咯血（CH）的发生率、治疗方法及效果。方法回顾性分析231例咯血患者,根据临床检查、胸片、支气管镜及胸部CT结果筛选CH患者,对其临床资料及治疗方法进行分析。结果本组CH的发生率为22.94%（53/231）。对45例（45/53,84.91%）CH患者进行内科保守治疗,对8例（8/53,15.09%）进行支气管动脉栓塞术。20例胸部HRCT可见磨玻璃影。8例支气管动脉造影示支气管动脉增粗、纡曲,3例出现支气管动脉-肺动脉分流。随访1~8年,无咯血复发。结论大部分CH经内科保守治疗能够取得良好止血效果,少部分咯血量较大者需接受介入栓塞治疗,两者均能够取得良好的近远期效果。     

DSA对咯血责任血管的诊断及栓塞治疗

目的探讨使用DSA寻找确定的咯血责任血管的来源及走行对咯血诊断及治疗作用。方法对89例咯血患者行选择性支气管动脉和相关动脉造影,寻找责任血管,明确咯血责任血管的来源及走行,并根据DSA结果行支气管动脉栓塞术(BAE)。结果咯血责任血管主要来源于支气管动脉(133/176,75.57%);其次来源于肋间动脉、膈动脉(34/176,19.32%),少见来源于肋颈干、胸廓内动脉、胸廓外动脉、甲状颈干、头臂干(9/176,5.11%)。31例检出多支咯血责任血管且不共干,49支为共干血管。支气管动脉-肺动脉瘘18例。接受BAE后治疗成功率为92.13%(82/89)。结论根据DSA发现的咯血责任血管,应注意多支咯血责任血管存在不共干和共干的可能,避免漏栓和误栓;并注意检出少见咯血责任血管,以提高咯血治疗成功率。此外DSA还能发现CTA不能发现的支气管动脉-肺动脉瘘。     

Use of sugammadex in patients with a history of pulmonary disease

Study ObjectiveTo evaluate the safety and efficacy of sugammadex for reversal of rocuronium-induced neuromuscular blockade in patients with pulmonary disease.DesignPhase III, randomized, multicenter, parallel-group, comparative, safety-assessor blinded study.SettingNine hospital sites.Patients77 ASA physical status 2 and 3 patients, aged ≥ 18 years, with a history of pulmonary disease, and scheduled for surgery with general anesthesia requiring neuromuscular blockade.InterventionsFollowing anesthesia induction, patients received rocuronium 0.6 mg/kg with 0.15 mg/kg maintenance doses as needed. Patients were randomized to receive sugammadex 2 mg/kg or 4 mg/kg after the last rocuronium dose at reappearance of the second twitch.MeasurementsSafety evaluations included adverse events, laboratory parameters, vital signs, and evidence of recurrent or residual neuromuscular blockade. Efficacy was evaluated as the time from sugammadex administration to recovery of the train-of-four (TOF) ratio to ≥ 0.9.Main ResultsSafety was comparable between doses, with no evidence of residual or recurrent neuromuscular blockade. Two bronchospasm cases were reported (4 mg/kg group), both in patients with asthma who received desflurane for anesthesia maintenance. Geometric mean (95% confidence interval) times to a TOF ratio of ≥ 0.9 were 2.1 (1.7 - 3.1) min (2 mg/kg) and 1.8 (1.5 - 2.7) min (4 mg/kg).ConclusionSugammadex 2 mg/kg and 4 mg/kg were well tolerated and effective in patients with a history of pulmonary disease. Bronchospasm is a possibility when administering sugammadex to patients with underlying pulmonary disease.     

Angiographic and histopathological study on bronchial-to-pulmonary vascular anastomoses on explants from patients with cystic fibrosis after bronchial artery embolisation

Labelled backgroundHaemoptysis is a life-threatening complication of cystic fibrosis (CF). One treatment is bronchial artery embolisation (BAE) using embolic-microspheres (EMs). During BAE, pulmonary arteries can be seen on digital subtracted angiography while iodine containing contrast material injection is performed in the bronchial artery. This suggests that EMs could go from bronchial to nontarget pulmonary arteries. The aim was to evaluate if EMs could be found inside pulmonary arteries on lung explants after BAE in transplanted CF patients.MethodsRetrospective observational study including patients with CF who underwent lung transplantation and had previously needed BAE. Clinical, chest CT angiography, and angiographic data were reviewed from medical records. Pathology examination of lung explants was performed to analyze the EMs anatomical localisation.ResultsEight patients were included between 2013 and 2015, four males with a mean age of 29 (19-45) years. All patients had bronchial artery hypertrophy on CT and bronchial-to-pulmonary artery shunting during BAE. On pathology examination, EM ≤800 µm were found in the pulmonary arteries in all patients and were responsible for distal branch occlusions. Two pulmonary infarcts were observed on CT angiography after BAE and confirmed histopathologically.ConclusionsEM migration from the bronchial to pulmonary arteries is a common occurrence after BAE in patients with advanced stage CF. Although BAE is a highly effective means of controlling haemoptysis in CF, studies on the optimal particle size are needed to preserve pulmonary artery circulation, because these results suggest that low size EMs could lead to nontarget embolisation.     

Aspergilloma: a series of 89 surgical cases

BACKGROUND: Surgery for pleuropulmonary aspergilloma is reputed to be risky. We reviewed our results, focusing attention on the postoperative complications. METHODS: During a 20-year period, 87 patients were operated on for pulmonary (86) or pleural (3) aspergillomas. Seventy-two percent of patients were complaining of hemoptysis. Eighty-nine resections were performed because there were two bilateral cases. Seventy percent of aspergillomas had developed in cavitation sequelaes from tuberculosis disease. Thirty-four patients had severe respiratory insufficiency that allowed us to perform only lobectomy (18), segmentectomy (2), or cavernostomy (14). RESULTS: Thirty-seven lobectomies (five with associated segmentectomies), two bilobectomies, 21 segmentectomies, 10 pneumonectomies, and 17 cavernostomies were performed. Total blood loss exceeded 1,500 mL in 14 cases, and 71% of patients required blood transfusion. There were five postoperative deaths (5.7%), related to respiratory failure (2), infectious complication (1), pulmonary embolus (1), and cardiorythmic disorder (1). Incomplete reexpansions were frequently seen in patients undergoing lobectomies or segmentectomies. No death or major complications occurred in asymptomatic patients. During follow-up, none of the patients had recurrent hemoptysis. CONCLUSIONS: Surgical resection of aspergilloma is effective in preventing recurrence of hemoptysis. It has low risk in asymptomatic patients and in the absence of underlying pulmonary disease. Incomplete reexpansion is frequent after lobectomy and segmentectomy, especially when there is underlying lung disease. Cavernostomy is an effective treatment in high-risk patients. Long-term prognosis is mainly dependent on the general condition of patients.     

COVID-19 in Solid Organ Transplantation: Disease Severity and Clinical Update

BackgroundSolid organ transplant (SOT) recipients are a complex, immunocompromised population in whom greater coronavirus disease 2019 (COVID-19) mortality has been reported compared with the general population.MethodsWe examined a retrospective cohort of 58 SOT recipients with first-wave COVID-19, comparing patients with severe and nonsevere illness. Additionally, SOT recipients are compared with general patients with first-wave COVID-19.ResultsOrgans transplanted included 38 kidneys, 8 livers, 5 hearts, and 3 pancreases. Average SOT recipient age was 57.4 years; 62% were male; 46.6% were African American 36.2% were white. Comorbidities included hypertension (86%), chronic kidney disease (86%), diabetes mellitus (50%), coronary artery disease (26%), and chronic obstructive pulmonary disease (14%). Twenty patients had severe COVID-19 (34.5%) and 38 had nonsevere disease (65.5%). Severe disease was more common in older SOT recipients with comorbidities and was associated with cough, dyspnea, pneumonia, C-reactive protein >10 mg/L, and platelet count <150/μL. Sex, race, body mass index, time from transplant, baseline immunosuppression, and diagnosis month did not differ among those with severe and nonsevere COVID-19. Seventy percent of SOT recipients were hospitalized vs 27.2% of general patients with COVID-19 and inpatient SOT recipients had a higher mechanical ventilation rate. Though a trend toward longer length of stay, higher intensive care unit admission, and greater inpatient mortality was observed (19.5% vs 14.8%), these differences were not significant.ConclusionsThe severe acute respiratory syndrome coronavirus 2 has greatly impacted SOT recipients. One-third of our SOT recipients seen during the first wave had severe illness with associated standard risk factors for poor outcome. Compared with general first-wave patients, more SOT recipients were hospitalized, although inpatient COVID-19 mortality did not significantly differ.