NBSA在咯血介入治疗中的意义及与胸膜增厚的关系

发布时间：2018-06-18 10:42

本文选题：咯血 + TAE　；参考：《山西医科大学》2013年硕士论文

【摘要】：目的强调责任NBSA(nonbr onchi al systemic arteries,非支气管性体动脉)的发现与栓塞对咯血治疗的意义,分析责任NBSA与病变侧胸膜增厚是否有相关性,以提示有无责任NBSA的存在,提高咯血治疗的疗效。方法收集自2008年11月至2013年4月就诊于我院急诊科或呼吸科,为治疗咯血入我科行介入治疗的40例患者。统计咯血患者中责任NBSA出现的情况及胸膜增厚的情况,分析责任NBSA的出现与胸膜增厚的有无相关性。结果 1.40名咯血患者,其中男30例,女10例；年龄60岁-80岁,平均年龄70.5岁；术前40名患者行胸部CT检查提示胸膜增厚有15人,介入治疗的过程中行系统性的胸主动脉和(或)锁骨下动脉造影发现：其中9例咯血与病理性NBSA(合计13支)有关。患者原发病为：肺癌4例；支气管扩张18例；隐原性咯血14例,；肺结核4例(2例行结核球肺叶切除术；2例行抗结核药物治疗)。于术中通过对咯血患者责任BA与NBSA的栓塞：其中34例患者术后咯血停止；4例患者在病变血管栓塞后仍有少量的咯血,经内科保守治疗后咯血停止；1例患者经栓塞病变血管后,与1周内再次出现咯血情况,行第二次TAE治疗,术后咯血情况好转(造影时发现已栓塞的责任血管再通)；1例病人因原发病治疗无效,死亡。 2.对责任NBSA出现的情况及胸膜增厚的发出情况的关系采用卡方检验,从分析结果可以看出,责任NBSA的出现于胸膜增厚之间是相关的。胸膜增厚可提示有责任血管的出现,责任血管通常是通过增厚的胸膜参与咯血的供血。结论 1. NBSA的未进行栓塞常常是咯血治疗效果欠佳及短期内再次复发的潜在的危险因素,因此NBSA的发现与栓塞对于TAE治疗咯血起着重要作用,责任NBSA的发现使选择性插管有地放失,栓塞提高咯血的治疗效果的同时减少了咯血复发的几率,避免了短期内2次治疗的情况。总之,引起咯血的因素很多,咯血的责任血管同样很复杂,因此栓塞责任血管对于止血治疗有决定性意义。 2.胸膜增厚与咯血的责任NBSA的出现有一定的相关性,因此发现咯血患者病变侧胸膜增厚时,(1)考虑BA栓塞后,有责任NBSA参与咯血的血供可能；(2)BA造影未见异常时,有NBSA参与供血的可能。即胸膜增厚不一定全伴有责任NBSA的出现,但责任NBSA的出现却往往伴有胸膜的增厚。
[Abstract]:Objective to emphasize the significance of finding and embolization of responsible NBSA-nonbr onchi al systemic arteries, for hemoptysis, and to analyze whether there is a correlation between responsible NBSA and pleural thickening of diseased side, so as to indicate the existence of responsible NBSA and improve the curative effect of hemoptysis. Methods from November 2008 to April 2013, 40 patients with hemoptysis were treated by interventional therapy in emergency department or respiratory department of our hospital. The occurrence of responsible NBSA and pleural thickening in hemoptysis patients were analyzed and the correlation between the occurrence of responsible NBSA and pleural thickening was analyzed. Results 1.Forty patients with hemoptysis, including 30 males and 10 females, aged from 60 to 80 years, with an average age of 70.5 years, 15 patients with pleural thickening were examined by chest CT before operation. Systematic angiography of thoracic aorta and / or subclavian artery during interventional therapy revealed that 9 cases of hemoptysis were associated with pathological NBSA (13 branches). The primary diseases were lung cancer (n = 4), bronchiectasis (n = 18), cryptogenic hemoptysis (n = 14), pulmonary tuberculosis (n = 4) and pulmonary tuberculectomy (n = 2). After operation, 34 patients with hemoptysis stopped hemoptysis and 4 patients still had a small amount of hemoptysis after vascular embolization, and hemoptysis stopped after conservative medical treatment. Hemoptysis occurred again in one patient after embolization of the diseased blood vessels and within 1 week. After the second Tae treatment, hemoptysis was improved after operation (one patient was found to have been embolized by recanalization of the responsible blood vessel when the angiography was performed, and 1 patient had no effect on the treatment of the primary disease. Death. 2. Chi-square test was used to analyze the relationship between the occurrence of responsible NBSA and the appearance of pleural thickening. From the analysis results, we can see that the appearance of responsible NBSA is related to pleural thickening. Pleural thickening may indicate the presence of responsible blood vessels, which are usually involved in hemoptysis by thickening the pleura. Conclusion 1. The non-embolization of NBSA is often a potential risk factor for the treatment of hemoptysis and recurrence in a short period of time. Therefore, the discovery and embolization of NBSA plays an important role in the treatment of hemoptysis. Embolization improves the effect of hemoptysis and reduces the chance of recurrence of hemoptysis. In short, there are many factors causing hemoptysis, hemoptysis responsible blood vessels are also very complex, so embolization responsible blood vessels for hemostatic treatment is decisive. 2. 2. There is a certain correlation between pleural thickening and the occurrence of the responsible NBSA for hemoptysis. Therefore, it is found that in hemoptysis patients, when pleural thickening occurs on the side of pleural thickening, the responsible NBSA may be involved in the blood supply of hemoptysis when there is no abnormality in hemoptysis. NBSA may be involved in blood supply. That is, pleural thickening is not always accompanied by the appearance of responsible NBSA, but the appearance of responsible NBSA is often accompanied by pleural thickening.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R56

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