变异支气管动脉超选择性插管的介入治疗

目的：评价在变异支气管动脉的情况下，行超选择性插管栓塞治疗各种病因咯血的技术和价值。方法：在9例支气管动脉变异的肺癌、支气管扩张咯血患者中，右支气管动脉与第3、4、5右肋闯动脉共干4例；左右支气管动脉共干1例；右下支气管动脉与左下支气管动脉共干2例；左支气管动脉由左第6肋间动脉约7cm处呈“T”形垂直发出1例；右支气管动脉由右锁骨下动脉发出1例。采用Seldinger经皮穿刺技术插管，先送入5F或6F的型号的Cobra导管行支气管动脉造影，继选择微导管对病变供血的支气管动脉分支逐支行超选择性插管造影，采用明胶海绵颗粒＋超液化碘油或／和PVA颗粒栓塞剂进行栓塞。结果：9例患者均插管成功，术后咯血停止及病情得到控制。无严重并发症发生。结论：应用微导管技术，行超选择性相关支气管动脉逐支插管，采用明胶海绵＋超液化碘油和／或PVA的介入方法，对变异的支气管动脉介入治疗是安全有效的。

Interventional therapy of patient with hemoptysis using superselective catheterization of variant bronchial artery

Objective To evaluate the clinical efficacy of superselective catheterization in treating patients with hemoptysis and variant bronchial artery.Methods Nine cases of hemoptysis caused by lung cancer and bronchiectasis and variant bronchial artery were studied.There were 4 cases of right bronchial artery sharing a common trunk with the 3rd,4th and 5th right intercostal artery,1 case of right and left bronchial arteries arising from a common trunk,2 cases of the right and left lower bronchial arteries arising from a common trunk,1 case of the left bronchial artery arising perpendicularity at 7 cm from the left intercostal artery like the letter "T",1 case of right bronchial artery arising from the right subclavian artery.The Sedinger technique was adopted beginning with bronchial arteriography using 6F or 5F cabra catheter followed by superselective arteriography of the relevant arterial branches using microcatheter and embolization.The embolic agents used were gelfoam particles hyperliquified iodized oil or combined with polyvinyl alcohol particles.Results The procedures was successful in all cases without severe complications,and hemoptysis stopped.Conclusion In case of variant bronchial artery in patients with hemoptysis,superselective catheterization of bronchial artery branch by branch using gelfoam hyperliquified iodized oil and/or polyvinyl alcohol proves to be an efficient and safe procedure in controlling hemoptysis.