急症大咯血的栓塞治疗

目的：评估支气管动脉栓塞术（BAE）对大咯血治疗的疗效,探讨BAE治疗大咯血的意义及对疗效的影响因素。方法：急症大咯血患者128例,均行动脉造影检查,明确出血血管,其中123例行BAE治疗,5例导管无法固定而放弃栓塞。结果：动脉造影共发现病变动脉265支,其中支气管动脉159支,非支气管动脉106支,123例患者栓塞后92例（74.8%）立即止血,14例（11.3%）有效,即时有效率86.2%,11例（8.5%）改善,6例（4.9%）无效;9例患者BAE0.5个月内复发出血者,再次造影发现1例原栓塞血管再通,8例发现新的出血动脉;11例患者在0.6～3个月内复发出血量〉100ml/24h而再次造影发现3例原栓塞血管再通,5例侧支血管形成。结论：BAE可以有效的控制大咯血,达到较好的近期疗效,而远期疗效不稳定;在复发出血中,出血动脉的遗漏栓塞是引起早期复发出血的重要因素,而侧支循环的形成则是引起中远期复发出血的重要原因。

The bronchial artery embolization in patients with massive hemoptysis

Objective：This study aimed to evaluate the value and the influence factors of bronchial artery embolization（BAE）in the treatment of massive hemoptysis.Method：The 128cases of patients with massive hemoptysis received bronchial arteriography.BAE was performed in 123of them,5cases failed to perform BAE because the catheter tip could not be fixed in arteries.Result：The 265abnormal arteries were found by arteriography.159were bronchial arteries and 106were nonbronchial arteries.The immediate cessation of hemoptysis was got in 92cases of patients（74.8%）after BAE and 14cases were effective（11.3%）.The massive hemoptysis ameliorated in 11cases（8.5%）and 6cases（4.9%）were invalid.Hemoptysis recurred in nine cases of patients within 5months after BAE.Reperfusion of the embolized artery was found in one cases and new feeding artery was observed in eight cases by angiography.There were 11cases of patients with recurred hemoptysis〉100ml/24hfrom half month to three months in our study.Reperfusion of the embolized artery was found in 3cases and new collateral vessels were observed in five cases by angiography.Recanalization of initial embolized artery was observed in three and collateral circulation formation in 5.Conclusion：BAE may result in immediate control of massive hemoptysis,but the long term effect was unstable.Incomplete embolization of all bleeding arteries in initial BAE is the important reason for early recurrent bleeding and collateralization may result to the recurrent bleeding in the long term.