支气管动脉栓塞治疗大咯血的远期疗效分析

目的 探讨支气管动脉栓塞术治疗大咯血的远期疗效及影响疗效的因素.方法 对89例肺结核、5例肺癌、2例支气管扩张症所致大咯血共96例患者行支气管动脉栓塞术治疗,术后进行为期1～6年的追踪观察,对咯血有无复发、复发的时间、复发的原因、相应的治疗及效果进行了统计,采用生存分析的寿命表法对咯血控制率进行分析.结果 94例(97.9%)成功施行了支气管动脉栓塞术,术后即刻停止咯血.术后30 d、90 d、1年及2年的咯血控制率分别为93.6%(88/94)、86.2%(81/94)、81.9(77/94)及78.7%(74/94).术后30 d内咯血复发9例,复发的主要原因是漏栓和血管再通.30 d后咯血复发5例,90 d后复发2例,复发的主要原因与非支气管动脉体循环侧支循环形成、肺内病灶进展以及继发感染有关.结论 支气管动脉栓塞术在治疗肺结核咯血时疗效确切.防止漏栓、加主干双重栓塞、注重治疗病因、预防感染有助于提高支气管动脉栓塞术治疗大咯血的远期疗效.

The long-term effect of embolization of bronchial artery in patients with massive hemoptysis

Objective To explore the long-term effect of bronchial artery, embolization (BAE) in patients with massive hemoptysis and the factors associated with prognosis. Methods Ninety six patients underwent BAE from 2002 to 2008 for the management of mass hemoptysis were retrospectively analyzed. Of them, BAE was successfully performed in 94 patients (mean age 43 years, age range 21 to 80 years), including active or inactive tuberculosis (89 cases), bronchiectasis (2 cases) and pulmonary carcinoma (5 cases). Results BAE resulted in an immediate cessation of hemoptysis in 94 of the initial 96 patients (97.9%). The rate of hemoptysis controlling at 30 d, 90 d, 1 year and 2 year after the BAE was 93.6% (88/94), 86. 2% (81/94), 81.9% (77/94) and 78.7% (74/94) respectively. Haemoptysis recurred in 9 patients in 30 days after the BAE due to missing of target vessel or recanalization. Five patients had recurrence of haemoptysis after 30 days and 2 patients recurrent after 90 days due to development of systemic collateral, progress in primary lesions and secondary infection. Conclusion BAE is an effective technique in the emergency treatment of massive hemoptysis. Avoiding missing target vessel, selecting the appropriate embolic material, paying attention to treatment of the primary disease after BAE, and preventing infection would improve the effects of BAE for massive hemoptysis.