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目的评价介入治疗支气管动脉-肺动脉瘘并大咯血的治疗效果及安全性。方法收集该院2009年1月—2014年12月收治的156例大咯血患者,经DSA血管造影显示合并支气管动脉-肺动脉瘘(BPS)65例,所有患者均行支气管动脉栓塞术(bronchial artery embolization,BAE)治疗,34例应用传统单纯明胶海绵(GS)栓塞治疗(传统组),31例采用永久双重栓塞法治疗(观察组),即应用三丙烯微球(Embosphere)联合GS或弹簧圈进行栓塞。术后规律随访12个月以上,对二组治疗效果及复发情况进行统计分析。结果所有患者均成功实施BAE,52例患者BAE术后24h内停止咯血,11例患者BAE术后72h内停止咯血,总有效率96.92%(63/65)。12个月内复发咯血12例(传统组10例,观察组2例),总复发率18.46%(12/65)。观察组复发率6.45%(2/31),低于传统组29.41%(10/34),二组复发率差异比较有统计学意义,P<0.05,所有病例均未发生严重并发症。结论支气管动脉永久双重栓塞治疗BPS并大咯血安全、有效,可明显降低复发率,临床效果满意。
Objective To evaluate the efficacy and safety of interventional treatment of bronchial artery-pulmonary arterial fistula and hemoptysis. Methods A total of 156 patients with massive hemoptysis admitted to our hospital from January 2009 to December 2014 were enrolled in this study. Totally 65 patients with bronchial artery-pulmonary arterial fistula (BPS) underwent DSA angiography. All patients underwent bronchial artery embolization , BAE). 34 patients were treated with conventional simple gelatin sponge (GS) embolization (conventional group) and 31 patients were treated with permanent double embolization (observation group). Embaphere combined with GS or coil embolism. Regular follow-up after 12 months or more, the two groups of treatment and recurrence of statistical analysis. Results All patients were successfully treated with BAE. Fifty-two patients stopped hemoptysis within 24 hours after BAE and 11 patients had hemoptysis within 72 hours after operation. The total effective rate was 96.92% (63/65). 12 cases of recurrent hemoptysis in 12 months (traditional group 10 cases, observation group 2 cases), the total recurrence rate was 18.46% (12/65). The recurrence rate in the observation group was 6.45% (2/31), which was lower than that in the traditional group (29.41%, 10/34). The recurrence rates in the two groups were statistically significant (P <0.05). No serious complications occurred in all cases. Conclusion Permanent double bronchial artery embolization in the treatment of BPS and hemoptysis is safe and effective, which can significantly reduce the recurrence rate with satisfactory clinical results.