咯血介入治疗VIP免费

【摘要】目的总结支气管动脉-肺循环瘘的DSA表现和介入治疗经验。方法21例咯血病人，经DSA证实存在支气管动脉-肺循环瘘，根据血管瘘的类型、数目、瘘口的大小、循环时间选择不同种类和大小的栓塞剂对瘘口和病变血管进行栓塞。对其中6例DSA可见到明确瘘口并且循环时间短于1sec的病人，先用明胶海绵颗粒对瘘口作预栓塞，然后用长约1mm的5-0真丝线段进一步栓塞。其余15例循环时间长于1sec者，直接用真丝线段进行栓塞。栓塞术后随访0.5~3y，评估治疗效果。结果DSA表现为支气管动脉-肺动脉瘘和支气管动脉-肺静脉瘘者分别为15例和6例，同时合并肋间动脉-肺循环瘘者5例。其中17例经支气管动脉栓塞后达到即刻止血效果，有3例栓塞术后咯血量明显减少，经保守治疗后痊愈出院。总有效率为95.2%。另1例因肋间动脉和锁骨下动脉参与供血，未能有效止血，在介入术后6h转胸外科手术治疗。经随访发现，有2例分别在介入栓塞后4m和11m复发，5例在19m内死于肺癌合并症。结论支气管动脉-肺循环瘘在咯血病人中是常见的血管异常，可加重咯血和心肺疾病的进展，经皮穿刺支气管动脉栓塞术是有效的治疗方法。【关键词】咯血；支气管动脉；栓塞，治疗性；治疗结果TheDSAfindingsandtheinterventionaltherapyexperienceofbronchialarterytopulmonarycirculationshunt.LVWei-fu*,ZHANGXing-ming,ZHANGXue-bin,ZHANGZhen-feng,HOUChang-long,HUShu-dong.*DepartmentofRadiology,AnhuiProvincialHospital,Hefei230001,China【Abstract】ObjectiveToanalysistheDSAfindingsandinterventionaltherapyexperienceofbronchialarterytopulmonarycirculationshunt(BPS).MethodsBPSwereconfirmedbyDSAin21patientswithhemoptysis.Thedisordervesselswereembolizedusingvariouskindsandsizesembolismparticleswithaccordingtotheshunttipeandnumber,theshuntorificesizeandcirculationtime.In6patientswithin1seccirculationtime,theshuntorificeswerepre-embolizedusinggelfoamparticles,and5-0silksegmentsmeasuringabout1mmwereusedforcompensativeembolism.Theremaining15patientsbeyong1seccirculationtimewereembolizedonlyusingsilksegments.ResultsAccordingtoDSAfindings,bronchialarterytopulmonaryarteryshuntandbronchialarterytopulmonaryveinshuntwereconfirmedin15and6patients,respectively.Amongthem,17patientsstopbleedinginstantlyafterembolization,andthebleedingdecreasedsignificantlyinthe3patients.Thetotaleffectiveratewas95.2%。Theremainingonewasinefficiencyduetothebloodsupplycomingfromintercostalarteriesandsubclavianartery,whowasperformedbysurgicalintervention6hoursafterembolization.Thefollowing-uprevealedthathemoptysisre-occurredin2patients4monthsand11monthsrespectivelyafterembolizationand5patientsdiedduetopulmonarycancerwithin19months.ConclusionBPSisacommonvesselabnormalityinthepatientswithhemoptysis.Itcanworsenhemoptysisandcardio-pulmonarydiseases.Transcatheterembolizationofthebronchialarteryisaneffectivetherapeuticmeans.【Keywords】Hemoptysis;Bronchialartery;Embolization,therapeutic;Treatmentoutcome-1-支气管动脉-肺循环瘘（bronchialarterytopulmonarycirculationshunt,BPS）是指支气管动脉与肺动脉或(和)静脉间的异常直接分流，同时合并咯血和心肺病变等一系列临床病征。BPS在咯血病人中约占3%[1]，既可以是咯血的原发病因，也可以继发在心肺疾病的基础上，并加重咯血和心肺疾病的进展。国内有作者介绍了肺动-静脉瘘的DSA表现和介入治疗经验[2，3]，但有关BPS的研究报告较少。BPS无论在影像学表现还是在病理生理学特点以及临床处理等方面均不同于肺动-静脉瘘。我院自2000年1月~2003年1月共行支气管动脉栓塞术319例，发现BPS21例，现将DSA表现和介入治疗经验报告如下。材料与方法一、一般资料男17例，女4例，年龄11~78岁,平均(52.5±24.6)岁。全部病人均有反复咯血，其中24h咯血量>300ml12例，咯血量10~300ml/d9例，病程0.5~21y。介...