逐级多重栓塞治疗顽固性大咯血的技术探讨和疗效观察

发布时间：2018-11-11 01:11

【摘要】：目的:探讨个体化逐级多重栓塞治疗顽固性大咯血的技术要点,对该栓塞方法的临床疗效进行评价,并分析体-肺循环分流的存在对术后疗效的影响。方法:回顾性分析采用个体化逐级多重栓塞法治疗的103例顽固性大咯血患者资料。通过造影明确责任血管的类型、数量、异常分支、肺循环和(或)肺周体循环分流情况后,结合疾病类型,以聚乙烯醇颗粒、海藻酸钠微球作为基础栓塞剂行个体化逐级多重栓塞治疗。术后根据患者咯血症状的改善情况判定早期(术后3个月)、中期(术后3~6个月)和远期(术后6个月)疗效。采用Kaplan-Meier生存曲线对个体化逐级多重栓塞法治疗顽固性大咯血的疗效进行评价。根据责任血管供血特点将患者分为伴体-肺循环分流(SPS)组和无SPS组,并采用Log-Rank检验比较2组患者的有效率和有效时间。结果:103例患者共检出责任血管215支,其中100例患者共196支行个体化逐级多重栓塞,8支行末梢栓塞治疗,11支行主干明胶海绵颗粒栓塞。103例患者术后随访6~50个月,中位随访时间21个月。即刻止血率为97.1%(100/103)。患者的1个月、3个月、6个月、1年、2年和3年的有效率分别为94.5%、93.2%、89.7%、88.9%、85.2%和76.6%。103例中,伴SPS组患者22例,无SPS组患者81例。伴SPS组和无SPS组患者的1年有效率分别为(69.5±0.11)%和(98.3±0.03)%;总有效率分别为55.6%和82.7%;中位有效时间分别为25(24.8±3.37)个月和42(42.2±1.50)个月。2组患者有效率和有效时间的差异均有统计学意义(2?=11.662,P0.01)。结论:根据责任血管的类型、数量、结构、走形和沟通情况,采用个体化逐级多重栓塞法对责任血管进行夯实栓塞,不仅使咯血得到及时、有效的控制,而且可显著降低由于责任血管再通、侧枝循环建立所致的早期、中远期复发率。但SPS的存在会影响该栓塞技术的临床疗效,所以造影过程中要注意查找SPS,并依据其结构特点给予个案化栓塞,尽可能达到夯实栓塞效果、提高术后疗效。
[Abstract]:Objective: to discuss the key points of individualized multiple embolization in the treatment of intractable massive hemoptysis, to evaluate the clinical effect of the embolization method and to analyze the influence of the presence of body-pulmonary circulation shunt on the postoperative outcome. Methods: the data of 103 patients with intractable hemoptysis were analyzed retrospectively. The type, quantity, abnormal branches, pulmonary circulation and / or peripulmonary circulation shunt of the responsible vessels were determined by angiography, combined with disease types, to polyvinyl alcohol granules, Sodium alginate microspheres were used as the basic embolization agent for individualized multilevel embolization. According to the improvement of hemoptysis symptoms, the early (3 months), the middle (3 ~ 6 months) and the long term (6 months after operation) were evaluated. The Kaplan-Meier survival curve was used to evaluate the efficacy of individualized multiple embolization in the treatment of intractable massive hemoptysis. According to the characteristics of responsible blood supply, patients were divided into two groups: (SPS) group and no SPS group. Log-Rank test was used to compare the effective rate and effective time of the two groups. Results: a total of 215 responsible blood vessels were detected in 103 patients. Among them, 196 branches were individually embolized, 8 branches were embolized by endings, 11 branches were embolized with gelatin sponge particles. 103 patients were followed up for 6 ~ 50 months after operation. The median follow-up time was 21 months. The immediate hemostasis rate was 97.1% (100 / 103). The effective rates of 1 month, 3 months, 6 months, 1 year, 2 years and 3 years of the patients were 94. 5%, 93. 2% and 89. 7%, respectively, and 88. 9% and 76. 6%, respectively, in which 22 patients were in the SPS group. No SPS group 81 cases. The 1-year effective rates of patients with SPS and without SPS were (69.5 卤0.11)% and (98.3 卤0.03)%, respectively, and the total effective rates were 55.6% and 82.7%, respectively. The median effective time was 25 (24.8 卤3.37) months and 42 (42.2 卤1.50) months, respectively. Conclusion: according to the type, quantity, structure, shape and communication of responsible blood vessel, the method of individualized multiple embolization can not only make hemoptysis timely, but also be controlled effectively. Moreover, the early, middle and long term recurrence rate caused by the establishment of collateral circulation and recanalization of responsible blood vessels was significantly reduced. However, the presence of SPS will affect the clinical efficacy of the embolization technique. Therefore, in the course of angiography, attention should be paid to look for SPS, and give it a case based on its structural characteristics, so as to achieve tamped embolization effect and improve the postoperative effect as far as possible.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.7

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