经导管栓塞治疗咯血的临床应用

目的探讨PVA微粒和/或可脱弹簧圈栓塞支气管动脉和/或肺外体循环动脉治疗咯血的临床应用价值。方法 2002年1月至2008年10月,20例咯血患者,病变支气管动脉和/或肺外体循环动脉应用PVA微粒和/或可脱弹簧圈栓塞。20例患者咯血的病因为,结核8例、肺癌4例、结节病4例、支气管扩张3例、结节穿刺活检1例。栓塞后,病例随访1～23个月。结果 20例患者,栓塞的技术成功率为95%。栓塞后24h内,所有栓塞的患者咯血停止。随访中,4例患者再次咯血。2例仅弹簧圈栓塞的患者在随访中因栓塞血管再通而复发。1例肺癌患者和1例结节病患者由于病变进展新生供给动脉和漏栓锁骨下动脉发出的供血动脉而复发。术中,没有严重并发症发生。结论咯血患者,栓塞术前常规行多排螺旋CT血管造影和胸主动脉造影检查有助于术中寻找供血的支气管动脉和肺外体循环动脉,避免供血动脉漏栓。仅用弹簧圈栓塞支气管动脉和肺外体循环动脉易于导致早期咯血复发。栓塞剂的选择应首选PVA颗粒,联合弹簧圈使用双重栓塞可取得即刻和长期止血效果。

Clinical application of transcatheter embolization in the treatment of acute massive hemoptysis

Objective To evaluate the value of transcatheter embolization of bronchial arteries and/or non-bronchial systemic arteries for the treatment of hemoptysis using polyvinyl alcohol and/or detachable coils. Methods Between January 2002 to October 2008, 20 patients with hemoptysis resulting from bronchoscopic biopsy of indeterminate lung nodules （n=1）, lung cancer （n=4）, tuberculosis （n=8）,bronchiectasis （n=3） or sarcoidosis （n=4） underwent embolization of the bronchial arteries and non-bronchial systemic arteries responsible for the bleeding using detachable coils and/or polyvinyl alcohol （PVA）. All of the patients were followed up for 1-23 months （average, 6 months）. Results In 20 patients, the success rate of the procedure was 95%. Hemoptysis was controlled in all patients within 24 hours of the embolization. Of four patients with recurrent hemoptysis, recanalization occurred in two patients who were embolized with only mechanical coils. In one patient with lung cancer and another patient with sarcoidosis, hemoptysis recurred because of recruitment of additional feeding arteries as well as non-embolization of a large feeding artery originating from the subclavian artery. No major complications were encountered. Conclusion In patients with hemoptysis, preoperative multi-slice CT angiography and thoracic aortography can demonstrate the arteries contributing to hemoptysis. Embolization of the bronchial arteries and/or non-bronchial systemic arteries with only coils is liable to early recurrence of hemoptysis. Embolization with combination of PVA and coils may result in immediate and long-term control of hemoptysis.