栓塞治疗顽固性咯血患者支气管动脉-肺动脉瘘

发布时间：2018-04-17 16:07

本文选题：咯血 + 支气管动脉-肺动脉瘘　；参考：《中国介入影像与治疗学》2015年09期

【摘要】：目的观察顽固性咯血患者的支气管动脉-肺动脉瘘(BPF)血管造影征象,探讨对不同类型BPF患者采用聚乙烯醇(PVA)颗粒和明胶海绵条行支气管动脉栓塞(BAE)的安全性及疗效。方法回顾性分析15例接受BAE治疗且存在BPF的顽固性咯血患者资料。均采用Seldinger法股动脉穿刺入路,行主动脉及支气管动脉造影,观察BPF的表现,采用医用PVA颗粒、明胶海绵条行栓塞治疗。术后严密监测并发症的发生,评价BAE术后疗效及随访咯血复发情况。结果对15例患者均采用PVA颗粒栓塞瘘口、病变区末梢供血动脉,明胶海绵条栓塞支气管动脉主干,BAE治疗成功率为100%(15/15),共成功栓塞21支病变动脉,影像学表现为瀑布型3支,枯枝型6支,斑片型12支。无异位栓塞、感染等严重并发症发生。治疗后随访1~3年,1年内3例复发,其中2例为肺癌患者,再次栓塞新病灶区后咯血停止,分别于15、17个月后死亡;另1例为肺结核患者,为痰中少量带血,经临床对症止血治疗一周后出院,未再发生咯血症状。结论支气管动脉-肺动脉瘘血管造影表现形式多样,采用PVA颗粒和明胶海绵条的栓塞均安全、有效。
[Abstract]:Objective to observe the angiographic features of bronchoarteriopulmonary fistula (BPF) in patients with intractable hemoptysis, and to investigate the safety and efficacy of using polyvinyl alcohol (PVA) granules and gelatin sponge strips for bronchial artery embolization (BAE) in patients with different types of BPF.Methods the data of 15 patients with intractable hemoptysis treated with BAE and with BPF were retrospectively analyzed.All patients were treated with Seldinger's femoral artery puncture approach, aortic and bronchial arteriography, and BPF findings were observed. Medical PVA granules and gelatin sponge strips were used for embolization.Postoperative complications were closely monitored to evaluate the effect of BAE and follow up the recurrence of hemoptysis.Results all the 15 patients were embolized with PVA granules to embolize the fistula, the peripheral blood supply artery in the lesion area, and the bronchial artery trunk embolization with gelatin sponge strip. The successful rate of embolization of 21 diseased arteries was 100 ~ 15 / 15. The imaging findings were waterfall type 3 arteries.There were 6 branches of withered branches and 12 branches of patch type.No serious complications such as ectopic embolism and infection occurred.After 1 ~ 3 years follow up, 3 cases recurred within 1 year, 2 cases were lung cancer patients, hemoptysis stopped after embolization of new focus area again and died after 15 months and 17 months respectively, the other case was pulmonary tuberculosis patient with a small amount of blood in sputum.After a week of clinical hemostasis treatment, no hemoptysis occurred again.Conclusion the angiographic manifestations of bronchial arteriopulmonary fistula are varied. Embolization with PVA granules and gelatin sponge strip is safe and effective.
【作者单位】：烟台市北海医院影像科;山东省北墅监狱医院影像科;
【分类号】：R56

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