支气管动脉-肺循环分流的不同处理方法及远期止血疗效

发布时间：2018-02-20 05:18

本文关键词： 栓塞剂支气管动脉-肺循环分流大咯血介入治疗　出处：《临床放射学杂志》2015年06期 　论文类型：期刊论文

【摘要】：目的探讨采用不同类型栓塞剂及栓塞方式栓塞支气管动脉-肺循环分流(BPS)的安全性及远期疗效。方法搜集129例大咯血患者中经DSA造影证实伴有BPS的89例为研究对象。89例中伴有原发病支气管扩张68例,肺结核13例,其他8例。术前均行支气管动脉CT成像(CTBA),依据CTBA行选择性支气管动脉造影。根据分流类型及分流量选用不同种类及规格的颗粒栓塞剂和(或)弹簧圈进行栓塞。其中,早期各型BPS丝线颗粒栓塞17例,早期中快速型BPS弹簧圈栓塞4例,后期各型BPS海绵颗粒栓塞19例,后期各型BPS PVA栓塞35例,后期分流量大伴快速型BPS弹簧圈+PVA栓塞9例,后期分流量大伴快速型BPS弹簧圈+海绵颗粒栓塞5例。术中严密观察血氧饱和度。栓塞成功标准:分流现象消失,靶血管闭塞。随访12~31个月。结果 89例中有56例非支气管体循环动脉(NBSA)参与供血,21例发现非支气管动脉-肺循环分流(NBSA-PS)。在DSA监视下均成功进行责任支气管动脉及NBSA栓塞治疗,术后即刻止血率100%,无脊髓损伤等严重并发症发生。随访中8例大咯血复发,复发时间1~15个月,发生率分别为丝线颗粒11.8%(2/17),海绵颗粒10.5%(2/19),弹簧圈100%(4/4)。结论支气管大咯血中各型BPS采用PVA颗粒或弹簧圈+PVA栓塞责任血管安全性高,远期止血疗效最优。
[Abstract]:Objective to investigate the safety and long-term efficacy of embolization of bronchial arterial-pulmonary shunt (BPS) with different embolization agents and methods. Methods 89 patients with severe hemoptysis confirmed by DSA angiography were studied. Of the 89 cases, 68 were associated with primary bronchiectasis, 13 cases of tuberculosis, The other 8 cases underwent CT angiography of bronchial artery before operation, selective bronchoarteriography based on CTBA. Different kinds and specifications of granular embolization and / or coils were selected according to shunt type and flow rate. There were 17 cases of early embolization of BPS filaments, 4 cases of early BPS coil embolization, 19 cases of late BPS sponge embolization, 35 cases of late BPS PVA embolization, and 9 cases of rapid BPS coils PVA embolization. In the later stage, 5 cases were embolized with large flow fraction and rapid BPS coil sponge particle embolization. Blood oxygen saturation was observed closely during operation. Successful embolization criteria: shunt disappeared. Target vessel occlusion was followed up for 12 to 31 months. Results among 89 cases, 56 cases were involved in the blood supply of NBSAs. NBSA-PSN was found in 21 cases of non-bronchial arterial-pulmonary shunt. The responsible bronchial artery and NBSA embolization were successfully performed under the surveillance of DSA. The hemostasis rate was 100% immediately after operation, and there were no serious complications such as spinal cord injury. During the follow-up, 8 cases of massive hemoptysis recurred, and the recurrence time was 1 ~ 15 months. The incidence rates were 11.8% of silk thread particles, 10.5% of spongy particles, 100% of spring coils and 4 / 4% of bronchohemoptysis. Conclusion PVA granules or coil PVA in various types of bronchohemoptysis are safe for embolization of blood vessels, and the long-term hemostatic effect is the best.
【作者单位】：三峡大学第一临床医学院;宜昌市中心人民医院介入科;宜昌市中心人民医院神经内科;
【分类号】：R459.7;R816.4

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