不同栓塞剂在体-肺循环瘘导致大咯血患者经导管栓塞治疗中的疗效比较

发布时间：2018-01-11 20:45

本文关键词：不同栓塞剂在体-肺循环瘘导致大咯血患者经导管栓塞治疗中的疗效比较　出处：《重庆医学》2017年30期 　论文类型：期刊论文

【摘要】：目的评估应用不同栓塞剂进行支气管动脉栓塞术治疗大咯血合并体-肺循环瘘(SPS)的疗效差别。方法回顾分析2005年3月至2014年2月安徽医科大学附属省立医院98例合并SPS大咯血患者的临床及影像学资料,其中支气管扩张72例、肺结核18例、肺癌8例,所有患者均行介入栓塞治疗。根据应用的栓塞剂材料不同分为明胶海绵栓塞组和聚乙烯醇颗粒栓塞组。所有患者均在术后1d,1、3、6个月,1、2年进行随访,并采用Ridit分析。结果 98例大咯血患者均行数字减影血管造影证实,其中合并肺动脉瘘84例,肺静脉瘘12例,混合瘘2例;单纯性支气管动脉-肺循环瘘(BPS)32例,支气管动脉与非支气管动脉同时存在肺循环瘘62例,单纯非BPS 4例。两组均无异位栓塞、截瘫、食管气管痿、皮肤缺血坏死等严重并发症。术后1d,1、3、6个月,1、2年的随访提示48例明胶海绵栓塞组中治愈20例,显效18例,有效6例,无效4例,有效率91.7%;50例聚乙烯醇颗粒栓塞组中治愈38例,显效8例,有效4例,无效0例,有效率100.0%。两组疗效经Ridit分析,差异有统计学意义(P0.01)。结论经导管栓塞治疗SPS导致的大咯血安全有效,创伤较小,应用聚乙烯醇颗粒栓塞可以降低咯血的远期复发率。
[Abstract]:Objective to evaluate the effect of bronchial artery embolization with different embolization agents in the treatment of massive hemoptysis combined with void-pulmonary circulation fistula (SPS). Methods from March 2005 to February 2014, the clinical and imaging data of 98 patients with severe hemoptysis associated with SPS in provincial hospital affiliated to Anhui Medical University were retrospectively analyzed. There were 72 cases of bronchiectasis, 18 cases of pulmonary tuberculosis and 8 cases of lung cancer. All patients were treated with interventional embolization. According to the material of embolization agent, they were divided into gelfoam embolization group and polyvinyl alcohol granule embolization group. Results 98 cases of massive hemoptysis were confirmed by digital subtraction angiography, including 84 cases of pulmonary artery fistula, 12 cases of pulmonary venous fistula and 2 cases of mixed fistula. There were 32 cases of simple bronchial arterial-pulmonary circulation fistula, 62 cases of bronchial artery and non-bronchial artery, and 4 cases of simple non-bronchial artery fistula. There was no ectopic embolization and paraplegia in both groups. Serious complications such as esophageal trachea impotence, ischemic necrosis of skin and so on. The follow-up of 1 day, 6 months and 2 years after operation showed that 20 cases were cured, 18 cases were effective and 6 cases were effective in 48 cases of gelfoam embolization group. 4 cases were ineffective, the effective rate was 91.7%; 38 cases were cured, 8 cases were markedly effective, 4 cases were effective, 0 cases were ineffective, and the effective rate was 100.0in the 50 cases of polyvinyl alcohol granule embolization group. The curative effect of the two groups was analyzed by Ridit. Conclusion Transcatheter embolization is safe and effective in the treatment of massive hemoptysis caused by SPS, and the trauma is relatively small. The long-term recurrence rate of hemoptysis can be reduced by using polyvinyl alcohol granule embolization.
【作者单位】：安徽医科大学附属省立医院介入放射科;海军安庆医院介入放射科;
【基金】：安徽省自然科学基金资助项目(1408085MH162)
【分类号】：R459.7
【正文快照】： 支气管动脉-肺循环瘘(bronchial artery to pulmonary cir-culation shunt,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在咯血患者中约占3%,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

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