咯血介入治疗.doc

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1、【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

2、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The DSA findingsandtheinterventionaltherapyexpe

3、rienceofbronchialarterytopulmonarycirculationshunt. LVWei-fu*,ZHANGXing-ming,ZHANGXue-bin,ZHANGZhen-feng,HOUChang-long,HUShu-dong.*DepartmentofRadiology,AnhuiProvincialHospital,Hefei230001,China 【Abstract】 Objective Toanalysisthe DSAfindingsandinterventionaltherapyexperienceofbronch

4、ialarterytopulmonarycirculationshunt(BPS). Methods BPSwereconfirmedbyDSAin21patientswithhemoptysis.Thedisordervesselswereembolizedusingvariouskindsandsizesembolismparticleswithaccordingtotheshunttipeandnumber,theshuntorificesizeandcirculationtime.In6patientswithin1seccirculation tim

5、e,theshuntorificeswere pre-embolizedusinggelfoamparticles,and5-0silksegmentsmeasuringabout1mmwereusedforcompensativeembolism.Theremaining15patientsbeyong1seccirculationtimewereembolizedonlyusingsilksegments.Results AccordingtoDSAfindings,bronchialarterytopulmonaryarteryshuntandbronc

6、hialarterytopulmonaryveinshuntwereconfirmedin15and6patients,respectively.Amongthem,17patientsstopbleedinginstantlyafterembolization,andthebleedingdecreasedsignificantlyinthe3patients.The totaleffectiveratewas95.2%。Theremainingonewasinefficiencyduetothebloodsupplycomingfromintercosta

7、larteriesandsubclavianartery,whowasperformedbysurgicalintervention6hoursafterembolization.Thefollowing-uprevealedthathemoptysisre-occurredin2patients4monthsand11monthsrespectivelyafterembolizationand5patientsdiedduetopulmonarycancerwithin19months. Conclusion  BPSisacommonvesselabnor

8、malityinthepatients