血管内栓塞术在肺部咯血性疾病大咯血治疗中的应用

目的探讨动脉血管内栓塞术在肺部咯血性疾病大咯血治疗中的应用方法和价值。方法采用30%的碘海醇非离子型碘剂对71例大咯血患者进行病变区血管造影,造影顺序按支气管动脉、肋间动脉、胸廓内动脉和病变部邻近部位动脉依次进行。根据出血部位血管管径等具体情况,选择明胶海绵颗粒或弹簧钢圈法进行血管内栓塞,栓塞后4周内无咯血者认定治疗成功。结果对71例患者共实施了193支异常血管栓塞处理,其中明胶海绵颗粒法栓塞血管185支(96%),弹簧钢圈法栓塞8支(4%)。一次介入栓塞成功止血63例(89%),再次栓塞成功止血8例(11%)。所有患者除感栓塞部位轻微疼痛外,未出现其他并发症。结论动脉血管内栓塞术具有操作简洁、显效快、成功率高、并发症轻且费用相对低廉等优势,值得在肺部咯血性疾病的治疗中推广应用。

Evaluation of Therapeutic Value of Intravascular Embolization in the Treatment of Massive Hemoptysis in Pulmonary Diseases

Objective To explore the methods and their clinical values of intravascular embolization for treatment of massive hemoptysis in pulmonary diseases. Methods Digital subtraction angiography (DSA) was carried out with 30% nonionic contrast medium-lohexol in 71 patients in a successive order of bronchial artery,intercostal artery,internal thoracic artery and arteries in diseased region. The Gelfoam particles or spring rings were used selectively according to the blood vessel diameter,etc. in the bleeding site. The patients without re-bleeding after 4 weeks of embolism were regarded as cured. Results Intravascular embolization was performed in the 193 vessels with 185 (96%) vessels by Gelfoam particles and 8 (4%) vessels by spring circles. Embolisation succeeded in controlling haemoptysis immediately after the first intervention in 63 patients (89%) and re-embolization in 8 patients (11%) with no recurrent hemoptysis. There were no procedure-related major complications in all patients except for slight pain. Conclusion Intravascular embolization is a safe,simple,economic,and effective palliative treatment for massive haemoptysis.