支气管动脉栓塞治疗肺结核大咯血疗效的探讨

目的评价支气管动脉栓塞治疗肺结核大咯血的疗效。方法26例均为继发性肺结核,双侧肺结核20例,单侧肺结核6例,咯血量200ml/d～1200ml/d。采用支气管动脉插管造影,证实为出血动脉后,将丝线剪成l～2mm线段或用PVA微粒,在电视监视下缓慢注入靶血管内,直至血流停止;2例支气管动脉高度扩张者,加用明胶海绵颗粒栓塞动脉主干。结果1次栓塞后23例达到立即止血目的,2例咯血明显减少,1例无效。近期有效率96.1%,无严重并发症。术后随访0.5～6年,23例病情稳定,3例半年后复发行第2次丝线段栓塞治疗,远期有效率88.4%。结论支气管动脉栓塞是一种安全有效的治疗肺结核大咯血的方法,尤其是对于急危重病人的抢救可达立竿见影之效,结合抗痨治疗有利于巩固疗效。

Massive hemoptysis due to pulmonary tuberclosis:management with bronchial artery emboliation

Objective To evaluate the clinical effects of interventional bronchial artery embolization in the management of massive hemoptysis as a complication of pulmonary tuberculosis. Methods Interventional bronchial arterial embolization was performed in 26 cases with secondary pulmonary tuberculosis and massive hemoptysis. Tuberculosis was found in bilateral lung in 20 cases out of 26 unilateral lung was envolved in the rest 6.The dose of hemoptysis was 200ml/d- 1200ml/d. Bronchial arteriography was undertaken and the target blood vessel was confirmed in all patients.Then PVA grain or silk segment(1- 2mm) were injected into bronchial artery until blood flow was was blocked.The procedures were guided under the fluoroscopy. Gelfoam particles were used in 2 cases when tortuous feeding arteries were revealed in angiogram. Results Bleeding was demonstrated in 58 branches of bronchial artery in all cases. 19 cases were bilatersl and 7 unilateral. After the primary intervention, hemoptysis was controlled completely in 23 patients, slight hemoptysis was noted in 2 patients, and no improvement was obtained in one patient .The short term efficiency was 96.1% .No serious complication occurred. In a post- interventinal follow up of 6 monthes to 6 years, 3 patients had relapse after 6 monthes and reembolization with silk segments was done.The other 23 patients were in stable condition. Long- term efficiency was 88.4% . Conclusion Embolization of bronchial artery with PVA grain or with tuberculosis is an effective and safe method in the management of hemoptysis as a complication of pulomnary tuberculosis, especially in patients with severe hemoptysis. The anti- tuberculosis chemotherapy is helpful in preventing the relapse.