支气管动脉加非支气管体动脉栓塞治疗大咯血的临床应用

目的评价支气管动脉(BA)联合非支气管体动脉(NBSA)在数字减影血管造影(DSA)下栓塞治疗大咯血的疗效及并发症。方法对130例接受经导管动脉栓塞(TAE)治疗的大咯血患者行系统的支气管动脉、肋间动脉、锁骨下动脉和膈下动脉造影,分别对出血及异常责任血管进行末梢及主干完全栓塞。随访观察临床疗效和并发症。随访时间6个月至5年。结果患者原发病为:肺结核64例,单纯性支气管扩张41例(1例有肺叶切除术史),支气管肺癌8例,隐原性咯血12例,尘肺3例,支气管囊肿1例,慢性肺栓塞1例。130例大咯血患者累计栓塞异常及出血动脉324支,其中BA210支(64.8%),NBSA114支(35.2%),114支中包括肋间后动脉64支、胸廓内动脉32支、甲状颈干11支、膈下动脉6支、食管固有动脉1支。本组患者TAE后,即刻止血129例,有效率达99.2%。术后随访复发3例,复发时间分别为3d、8月和1年,其中1例为胸廓内动脉再次出血,1例为肋间动脉再通出血,1例未发现异常血管,经支气管动脉注入立止血3U、手术结束3d后再次咯血。本组病例术后胸闷11例;胸痛5例;术后第2天前胸壁轻度红肿1例,系栓塞右侧内乳动脉;1例术后第2天下床活动时感觉右下肢轻度无力,2周后症状消失;其余无严重并发症。结论大咯血患者具有多支动脉供血情况并非少见,有必要栓塞前全面探查病灶供血动脉。针对病灶的多支供血动脉栓塞是治疗大咯血的一种安全、有效的方法。

Clinical application of embolization of bronchial artery plus non-bronchial systemic artery for treating massive hemoptysis

Objective To evaluate the efficacy and complications of embolization of bronchial artery(BA) and non-bronchial systemic artery(NBSA) under digital subtraction angiography(DSA) for treating massive hemoptysis.Methods A total of 130 patients with massive hemoptysis treated by transcatheter arterial embolization(TAE) of bronchial and non-bronchial systemic arteries under guidance of DSA between August 2006 and August 2010 were recruited in present study.The bronchial artery,intercostal artery,subclavian artery and the inferior phrenic artery were carefully sought under DSA for finding the culprit vessels.The endings and trunk of abnormal and hemorrhagic vessels were completely embolized.All patients were followed-up for 6 months to 5 years.The clinical efficacy and complications were observed.Results The primary diseases in 130 patients with massive hemoptysis were as follows:pulmonary tuberculosis in 64 cases,simple bronchiectasis in 41 cases(1 case had a history of pulmonary lobectomy),lung cancer in 8 cases,cryptogenic hemoptysis in 12 cases,pneumoconiosis in 3 cases,bronchial cyst in 1 case,chronic pulmonary embolism in 1 case.In 130 patients with massive hemoptysis,embolized abnormal and bleeding arteries included 210 BA(64.8%)and 114 NBSA(35.2%),in which the posterior intercostal artery was 64 branches,internal thoracic artery was 32 branches,thyrocervical trunk was 11 branches,inferior phrenic artery was 6 branches,esophageal inherent artery was 1 branch.Of 130 cases,129 immediate stopped bleeding after TAE,and the effective rate was 99.2%.The postoperative recurrence occurred in 3 cases at 3 days,8 months and 1 year after operation respectively:1 case was internal thoracic artery bleeding again,1 case was intercostal artery recanalization bleeding,1 case was no abnormal vessels to be found(reptilase of 3 units was infused through bronchial artery) but occurred hemoptysis again 3 days after procedure.Complications were as follows:chest distress occurred in 11 cases and chest pain in 5 cases after operation;mild swelling of anterior chest wall at the second day after operation occurred in 1 cases because of embolization of right internal mammary artery;mild weakness of right lower limb at the second day after operation when moving got out of bed occurred in 1 case,and it disappeared after 2 weeks.The remaining were no severe complications.Conclusions In patients with massive hemoptysis,the situation with multi-arterial blood supply led to bleeding is not uncommon,and hence full looking for the arteries of blood supply of the lesion before embolization is essential.TAE aimed at multi-arteries of blood supply of lesions for treating massive hemoptysis is a safe and effective method.