介入治疗大咯血的临床应用

目的　研究介入治疗大咯血的临床价值。方法　 2 0例经内科治疗无效的反复咯血患者 ,咯血史 3个月～ 12年不等 ,发病时咯血量 30 0～ 80 0ml 2 4h ,其中肺结核 8例 ,支气管扩张 6例 ,肺血管畸形 1例 ,肺癌伴咯血 5例。采用Seldinger技术 ,行超选择性支气管动脉栓塞治疗。栓塞材料先用 1mm×1mm× 1mm的明胶海绵颗粒 ,待血流缓慢或停止后 ,用血管栓塞胶 (D TH)以栓塞供血主干。常规行患侧锁骨下动脉、肋间动脉及对侧支气管动脉造影。以了解有无多支供血 ,发现供血血管则尽量行超选择插管栓塞治疗。结果　 2 0例患者均 1次栓塞成功 ,即刻止血 18例 ,咯血明显减少 2例 ,有效率 10 0 %。无严重并发症发生。结论　介入治疗对内科治疗无效的咯血患者是一种有效、安全的治疗方法

Double interventional treatments for massive hemoptysis

Objective To evaluate the effect of double interventional embolization for treatment of massive hemoptysis. Methods Between 2000 and 2002, 20 patients (13 men and 7 women, mean age 48.6 years) who presented with massive hemoptysis (300 ml to 800 ml of blood in 24 hours underwent bronchial artery embolization (BAE). The main etiologies of hemoptysis were tuberculosis (8 patients), bronchiectasis (6 patients), lung cancer (5 patients) and arteriovenous malformation of the lung (1 patient). Embolization was performed with the following methods: branches of bronchial artery participated embolization with particles of gelfoam, the main trunk of bronchial artery obturation with medical embolism glue (D-TH). Other feeding arteries should be also found and embolized. Results Embolization was carried out in 20 patients. Immediate control of hemoptysis was achieved in 18 patients. Evident hemostasis was obtained in 2 patients. Total hemoptysis control rate was 100% with no serious complication. Conclusions Double interventional embolization is an effective and safe treatment to the patients with massive hemoptysis.