中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2012年
23期
16-18
,共3页
巩曰红%常刚%裴维芳%张晓燕%李洪福
鞏曰紅%常剛%裴維芳%張曉燕%李洪福
공왈홍%상강%배유방%장효연%리홍복
支气管动脉栓塞%咯血%治疗结果
支氣管動脈栓塞%咯血%治療結果
지기관동맥전새%각혈%치료결과
Bronchial arterial embolization%Hemoptysis%Treatment outcome
目的 观察选择性支气管动脉栓塞对大咯血患者的临床疗效.方法 选择因大咯血住院患者38例,其中反复咯血31例,支气管扩张27例,支气管肺囊肿4例,不明原因4例,肺结核3例.均经胸部影像学检查或纤维支气管镜、支气管动脉造影明确诊断,且均行选择性支气管动脉栓塞治疗.结果 患者栓塞次数最多3次,支气管动脉造影均表现为血管畸形,给予选择性支气管动脉栓塞治疗,35例出血立即减少.8例患者治疗后24h再次复发咯血,其中1例患者经保守治疗无效后行右上肺切除术,5例患者经保守治疗后有效,2例患者经保守治疗后无效行再栓塞治疗,1周内咯血完全消失,总有效率97.4%( 37/38).随访1年,再次复发大咯血13例,11例每次咯血及年总咯血量较治疗前减少50%以上,2例再咯血患者经多次栓塞剂栓塞保守治疗无效后行右上肺切除术,总有效率94.7%(36/38).治疗后3例短时间内轻微胸痛,2例肩痛,3例伴胸闷,3例腹股沟皮下淤血,对症处理后短期内好转. 结论 选择性支气管动脉栓塞治疗急性或反复发生的大咯血疗效显著,可以避免患者外科手术的风险,对复发患者再次治疗也安全有效,值得临床推广应用.
目的 觀察選擇性支氣管動脈栓塞對大咯血患者的臨床療效.方法 選擇因大咯血住院患者38例,其中反複咯血31例,支氣管擴張27例,支氣管肺囊腫4例,不明原因4例,肺結覈3例.均經胸部影像學檢查或纖維支氣管鏡、支氣管動脈造影明確診斷,且均行選擇性支氣管動脈栓塞治療.結果 患者栓塞次數最多3次,支氣管動脈造影均錶現為血管畸形,給予選擇性支氣管動脈栓塞治療,35例齣血立即減少.8例患者治療後24h再次複髮咯血,其中1例患者經保守治療無效後行右上肺切除術,5例患者經保守治療後有效,2例患者經保守治療後無效行再栓塞治療,1週內咯血完全消失,總有效率97.4%( 37/38).隨訪1年,再次複髮大咯血13例,11例每次咯血及年總咯血量較治療前減少50%以上,2例再咯血患者經多次栓塞劑栓塞保守治療無效後行右上肺切除術,總有效率94.7%(36/38).治療後3例短時間內輕微胸痛,2例肩痛,3例伴胸悶,3例腹股溝皮下淤血,對癥處理後短期內好轉. 結論 選擇性支氣管動脈栓塞治療急性或反複髮生的大咯血療效顯著,可以避免患者外科手術的風險,對複髮患者再次治療也安全有效,值得臨床推廣應用.
목적 관찰선택성지기관동맥전새대대각혈환자적림상료효.방법 선택인대각혈주원환자38례,기중반복각혈31례,지기관확장27례,지기관폐낭종4례,불명원인4례,폐결핵3례.균경흉부영상학검사혹섬유지기관경、지기관동맥조영명학진단,차균행선택성지기관동맥전새치료.결과 환자전새차수최다3차,지기관동맥조영균표현위혈관기형,급여선택성지기관동맥전새치료,35례출혈립즉감소.8례환자치료후24h재차복발각혈,기중1례환자경보수치료무효후행우상폐절제술,5례환자경보수치료후유효,2례환자경보수치료후무효행재전새치료,1주내각혈완전소실,총유효솔97.4%( 37/38).수방1년,재차복발대각혈13례,11례매차각혈급년총각혈량교치료전감소50%이상,2례재각혈환자경다차전새제전새보수치료무효후행우상폐절제술,총유효솔94.7%(36/38).치료후3례단시간내경미흉통,2례견통,3례반흉민,3례복고구피하어혈,대증처리후단기내호전. 결론 선택성지기관동맥전새치료급성혹반복발생적대각혈료효현저,가이피면환자외과수술적풍험,대복발환자재차치료야안전유효,치득림상추엄응용.
Objective To observe the clinical curative effect of selective bronchial arterial embolization for severe hemoptysis.Methods Thirty-eight hospitalized patients with severe hemoptysis was enrolled in this study.Of which 31 patients were recurrent hemoptysis,27 patients were with bronchiectasis,4 patients were with bronchial lung cysts,4 patients had unknown causes,3 patients were with tuberculosis.All patients were diagnosed by chest imaging examination,fiber bronchoscopy,bronchial arteriography,and they were all treated by selective bronchial arterial embolization.Results The most times of embolization was 3,and bronchial arterial imaging were performed for vascular malformation.After having bronchial arterial embolization,35 patients were immediately released of bleeding.Postoperative 24 h,8 patients had hemoptysis again,of which 1 case was performed with conservative treatment and subsequently had pneumonectomy,5 patients had effective conservative treatment,2 cases were performed embolization again after failed conservative treatments.Hemoptysis completely disappeared within 1 week.The total effective rate was 97.4%(37/38).Patients were followed up for 1 year,of which 13 patients relapsed again,11 patients'annual and each time's quantity of hemoptysis reduced 50%.Two patients had pneumonectomy after a number of embolization.The total effective rate was 94.7% (36/38).After treatment,3 patients had mild chest pain in short time,2 patients had shoulder pain,3 patients had chest tightness,and 3 patients had subcutaneous passive congestion.After being treated for short-term,these symptoms disappeared eventually.Conclusion Selective bronchial arterial embolization for the treatment of acute or recurrent severe hemoptysis is very effective,and can avoid the risk of surgery.It is effective for recurrent cases and worthy of clinical application.