隐源性大咯血的DSA表现及栓塞治疗

目的 探讨隐源性大咯血的支气管动脉造影表现及病理基础，支气管动脉栓塞效果。方法 隐源性大咯血定义为胸片和CT未发现明显病灶或原有病灶与咯血部位不一致，无法解释咯血原因。选择隐源性大咯血患19例，进行支气管动脉造影观察血管异常情况，进行支气管动脉栓塞观察术后即时止血率及长期随访止血率。结果 全部病例支气管动脉造影均可见血管异常，为支气管动脉增粗、分支增生、增多、扭曲，部分伴有出血灶，并可见支气管动脉畸形；经支气管动脉栓塞后即时止血效果及长期止血效果好，未见咯血部位恶性肿瘤发生，均为良性病变。结论 隐源性大咯血病理改变为支气管动脉因炎症感染损伤所致出血或肺血管畸形所致出血，支气管动脉造影和支气管动脉栓塞为一种安全可靠，有时是唯一的诊断、治疗方法，未见与技术操作有关的严重合并症。

Image manifestatons of bronchial arteriography and results of bronchial artery embolization for massive occult hemoptysis

Objective To clarity the image manifestation o f BAG(bronchial arteriography)and pathologic mechanism ,results o f BAE(bronchial artery embolization)for the massive occult hemoptysis .Methods The massive occult hemoptysis were d efined that chest radiograph and /or CT(computed tomography)were negative or some lesions showed by these image examinations were not the sites of hemopty-sis proved by BAG and can not explain t he signs of bleeding.19patients of t he massive occult hemoptysis were performed BAG to observe abnormal phenomena of bronchial artery and BAE to observe the immediate e ffects and long -term results of nonr ecurrence.Results All patients`BAGshowed abnormal vessels,includ ed different degree hypervascularity,proliferation and derangement.Serious cases were accom-panied by bleeding stains in the segm ent or lobe.Some patients have broncho -arterial fistula or arteriovenous malformation.Their immedi-ate effects and long -term results of BAE were very satisfactory and no lun g cancer was found in the bleeding sit es ,they were all benign diseases.Conclusion Pathologic mechanism of the massive occult hemoptysis is the damage of br onchial artery ,which are mainly caused by bronchitis and infection a nd some caused by bronchial arterial deformity.BAG and BAE are proven to b e effective and even only means for diagnosing and treating th e massive occult hemoptysis and there were no severe complications related to the procedure.