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目的探讨多种材料复合栓塞支气管动脉治疗大咯血的临床疗效及咯血复发的原因。方法搜集经内科治疗无效的97例大咯血患者的临床资料进行回顾性分析。采用多种栓塞材料,对支气管动脉进行逐级、多方位复合栓塞,术后随访患者2个月~2年,观察栓塞治疗的效果、复发咯血的时间及原因并进行分析与总结。结果97例患者均成功进行了栓塞治疗,其中94例术后咯血即止。随访至2个月时,共10例咯血复发,其中8例属于责任血管漏栓,2例为结核病灶进展致再发咯血。在2个月后的随访中,共8例咯血复发,原因均为原基础病灶进展(6例结核,2例肺癌)。所有患者中未见有因栓塞血管再通而复发咯血者。17例复发者中16例给予2次栓塞治疗后未再发咯血,1例肺结核患者复发2次,行第3次栓塞治疗后咯血停止。结论多材料复合栓塞可减少栓塞血管的再通率,其栓塞彻底、止血效果显著、疗效确切。责任血管漏栓及术后原发病灶进展是其咯血复发的主要原因。
Objective To investigate the clinical efficacy of multiple materials combined with embolization of bronchial artery in the treatment of massive hemoptysis and the causes of recurrence of hemoptysis. Methods A retrospective analysis was performed on the clinical data of 97 patients with massive hemoptysis who were ineffective in medical treatment. A variety of embolic materials, the bronchial artery step by step, multi-directional embolization, postoperative follow-up of patients 2 months to 2 years, the effect of embolization observed, the time and the reason of recurrent hemoptysis were analyzed and summarized. Results 97 patients were successfully embolized, of which 94 cases of hemoptysis only. Follow-up to 2 months, a total of 10 cases of recurrence of hemoptysis, of which 8 cases were responsible for vascular leak, 2 cases of tuberculosis lesions caused by the recurrence of hemoptysis. In 2 months after follow-up, a total of 8 cases of recurrence of hemoptysis, the reasons are the basis of the original lesion (6 cases of tuberculosis, 2 cases of lung cancer). No patients had recurrent hemoptysis due to recanalization of the vessel. Sixteen of the 17 relapsed patients were given 2 cycles of embolization without recurrence of hemoptysis. One patient with recurrent pulmonary tuberculosis recurred 2 times, and the third embolization was stopped. Conclusion Multi-material composite embolization can reduce the recanalization rate of embolized blood vessels, and its embolization is complete, the hemostatic effect is significant and the curative effect is definite. Responsible vascular leakage and postoperative primary lesion is the main reason for the recurrence of hemoptysis.