经支气管动脉栓塞术治疗肺结核大咯血的疗效

目的探讨经支气管动脉栓塞术治疗肺结核大咯血的安全性及临床疗效。方法对48例肺结核大咯血患者经支气管动脉造影明确出血动脉后行经支气管动脉栓塞术,采用聚乙烯醇颗粒、明胶海绵颗粒或明胶海绵条、或联合弹簧钢圈进行栓塞。48例患者随访3-12个月,观察48例患者有无经支气管动脉栓塞术后再次出血。结果 48例患者中,36例支气管动脉破裂患者中5例合并动静脉瘘,2例肋间动脉破裂患者中1例合并动静瘘,6例支气管动脉合并肋间动脉破裂,4例支气管动脉-肺动脉瘘患者中1例合并肺静脉瘤。46例患者术后无复发,其中1例患者并发应激性溃疡发生消化道大出血而死亡;2例患者于随访期内再次咯血,行第2次经支气管动脉栓塞术治疗后无再次咯血。结论对肺结核大咯血的患者行经导管支气管动脉栓塞术,其创伤小,并发症少,疗效显著,可作为结核性大咯血经内科治疗效果不佳患者的首选治疗方法。

Bronchial Arterial Embolization for Massive Hemoptysis due to Pulmonary Tuberculosis

Objective To explore the safety and efficacy of bronchial arterial embolization for the treatment of massive hemoptysis due to pulmonary tuberculosis.Methods Bronchial arterial embolization was performed after bronchial arteriography with polyvinyl alcohol particles,gelatin sponge particles or gelatin sponge,or in combination with steel coils in 48 patients with massive hemoptysis due to pulmonary tuberculosis.All patients were followed up for 3 to 12 months to observe the recurrence of hemoptysis after bronchial arterial embolization.Results Five of 36 patients with bronchial artery rupture and 1 of 2 patients with intercostal artery rupture had arteriovenous shunt.Six patients with bronchial artery rupture had intercostal artery rupture.One of 4 patients with bronchial-pulmonary artery shunt had pulmonary venous aneurysm.No recurrence of hemoptysis occurred in 46 paients,but 1 patient died of gastrointestinal hemorrhage due to stress ulcer complications among them.Two patients showed recurrence of hemoptysis during follow-up,but had no further hemoptysis after the second bronchial arterial embolization.Conclusion Bronchial arterial embolization may be used as the first choice of treatment for patients with massive hemoptysis due to pulmonary tuberculosis owing to its little invasion and fewer complications.