咯血患者支气管动脉栓塞治疗后复发原因分析.docVIP

咯血患者支气管动脉栓塞治疗后复发原因分析 丁明超1，程钢1，张晓丽2 （北京老年医院（北京胸科医院）放射科 ，北京 海淀 100095） 【摘要】 目的 探讨咯血患者支气管动脉栓塞（BAE）术后咯血复发的原因及预防措施。方法 632例咯血患者接受支气管动脉栓塞术，进行分阶段疗效追踪，全部病例随访12～14个月，复发病例通过再次手术，确定咯血的复发原因。结果 632例中有114例咯血复发，复发的原因主要有: 病变血管漏栓（3例）、肺循环供血（2例）、病变血管再通（32例）、侧支循环形成（55例）和原发病进展（54例）。采用合理的栓塞技术和栓塞物质组合联合栓塞，寻找所有可能对病变区域供血的血管（支气管动脉、肋间动脉、胸廓内动脉、食管固有动脉、膈动脉等）并予以栓塞，并积极的治疗原发病是预防咯血复发的主要措施。 结论 充分的认识患者支气管动脉栓塞术后咯血原因对降低复发率有重要的意义。 【关键词】咯血；支气管动脉栓塞；治疗性；复发 Cause of Recurrence after Bronchial Artery Embolization in Hemoptysis Ding Mingchao1 ,Cheng Gang1,Zhang Xiaoli2 (Department of Radiology ,BeiJing Geriaterics Hospital ,BeiJing HaiDian 100095 ,China) 【Abstract】 Objective To investigate the effect and the key factors associate with relapse and preventions of recurrence in hemoptysis in (BAE). Methods 632 with hemoptysis were performed selective BAE or superselective BAE . All patients had been followed up for 12 to 14 months ,with the second embolized if relapse .The causes for relapse was determined ,and the effect was evaluated. Results There are 114 cases hemoptysis relapsed in all patients.The causes of recurrence included missing embolization of (n=3), blood suply form pulmonary circulation (n=2), reopening of embolized diseased artery(n=32), blood suply form other systemic circulation(n=55)and deterioration of the primary disorders(n=54). The main measures to prevent recurrence of hemoptysis were as follows:The first is using different embolic agents tageter for treating massive hemoptysis ;The second is makinggreat effort to search the diseased feeding artery ,including bronchial,intercostals,internal ,intrathoracic ,phrenic,etc arteries ;the third is enhancing the treatment of the primary disease . Conclusion A knowledge of the causes of recurrence in hemoptysis after embolization treatment is great help for its prevention. [Key Words] Hemoptysis;Bronchial artery embolization; Therapty;Recurrence 支气管动脉栓塞术（Bronchial artery embolization BAE）治疗咯血已取得满意的效果，即刻止血有效率可达76.7%～96.0%左右[1～2]，并已得到广泛的临床应