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。

Causes and precautions of recurrent emptysis after transcatheter bronchial artery embolization

Objective To evaluate the causes and precautions of recurrent emptysis after transcatheter bronchial artery embolization (BAE). Methods Totally 85 patients with emptysis underwent selective or superselective BAE, among them 37 were embolized with gelatin sponge (GS), 48 patients were embolized with polyvinyl alcohol (PVA) and GS (PVA+GS). All patients were followed up 6 to 18 months, and patients with recurrent emptysis underwent the second embolization after the causes for relapse were identified. Results Emptysis recurred in 17 patients (20.00%), among which 13 (35.14%) were embolized with single GS, the causes of recurrent emptysis including recanalization of previously embolized artery (n=8), bronchial artery missed embolization (n=2), nonbronchial systemic artery supply (n=1), nonbronchial systemic collateral supply (n=2); 4 (8.33%) patients were embolized with PVA+GS, the causes of recurrent emptysis including neovascularization of the underlying diseases (n=3) and nonbronchial systemic collateral supply (n=1). Conclusion The recurrent emptysis after BAE is related to the choice of embolic agents, interventional techniques and underlying diseases. The rate of recurrence can be effectively reduced with resonably choosing of embolic agents, repeating of embolization and active treatment of underlying diseases.