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目的:评价在动脉硬化严重、插管困难的支气管动脉破裂咯血患者中,超选择性支气管动脉插管的技术应用和治疗价值。方法:18例动脉硬化严重的患者中:肺癌11例,肺癌并支气管动脉破裂出血2例,支气管扩张咯血5例;采用Seldinger经皮穿刺技术,首先送入5F或6F型号的Cobra导管做支气管动脉造影,继选择微导管(SP导管、Magic导管)行超选择性支气管动脉病变分支造影,使用明胶海绵颗粒+超液化碘油和／或PVA颗粒栓塞剂栓塞。结果:18例患者超选择性插管栓塞均成功,术后咯血停止。对4例动脉硬化严重插管不能进入到支气管口部者,采取探出插管法获得成功。对1例78岁动脉硬化严重、病变血管不能超选插入者,尝试血管内膜损伤法、继发血栓形成栓塞获得成功。无严重并发症发生。经1～11年随访观察术前咯血者无再咯血发生,肿瘤患者得到较满意控制。结论:应用微导管技术,行超选择性支气管动脉插管,采用明胶海绵+超液化碘油和／或PVA的介入方法,特殊情况下用导丝或微导管探出插管法、栓塞用血管内膜损伤法栓塞,对治疗动脉硬化严重支气管动脉破裂咯血和肺癌的患者是行之有效的。
OBJECTIVE: To evaluate the technical application and therapeutic value of super selective bronchial artery cannulation in patients with severe arteriosclerosis and difficult intubation of bronchial artery with hemoptysis. Methods: Among 18 patients with severe atherosclerosis, 11 were lung cancer, 2 were bronchial rupture and 2 were bronchial hemorrhage and 5 were bronchiectasis hemoptysis. Seldinger percutaneous puncture was used to deliver 5F or 6F Cobra as bronchial artery Followed by selective micro-catheter (SP catheter, Magic catheter) line super-selective bronchial artery disease branchography, the use of gelatin sponge particles + liquefied iodized oil and / or PVA embolization embolization agent. Results: 18 patients with super selective catheter embolization were successful, hemoptysis stopped. 4 cases of atherosclerosis severe intubation can not enter the mouth of the bronchus, to take out the intubation method to be successful. A case of 78-year-old severe atherosclerosis, lesions can not be super-inserted into the blood vessels, try to intimal injury, secondary thrombosis embolization was successful. No serious complications occurred. After 1 to 11 years of follow-up showed no hemoptysis occurred in patients with hemoptysis, tumor patients were more satisfactory control. CONCLUSIONS: Micro catheter technique is used to perform super selective bronchial arterial cannulation with gelatin sponge and ultra liquefied lipiodol and / or PVA. In special cases, catheterization or microcatheter is used to explore the method of intubation, embolization Intimal injury method of embolization, for the treatment of atherosclerosis in severe bronchial artery hemorrhage and lung cancer in patients with hemoptysis is effective.