《咯血介入治療》word版

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1、【摘要】目的?總結(jié)支氣管動脈-肺循環(huán)瘺的DSA表現(xiàn)和介入治療經(jīng)驗(yàn)。方法??21例咯血病人，經(jīng)DSA證實(shí)存在支氣管動脈-肺循環(huán)瘺，根據(jù)血管瘺的類型、數(shù)目、瘺口的大小、循環(huán)時間選擇不同種類和大小的栓塞劑對瘺口和病變血管進(jìn)行栓塞。對其中6例DSA可見到明確瘺口并且循環(huán)時間短于1sec的病人，先用明膠海綿顆粒對瘺口作預(yù)栓塞，然后用長約1mm的5-0真絲線段進(jìn)一步栓塞。其余15例循環(huán)時間長于1sec者，直接用真絲線段進(jìn)行栓塞。栓塞術(shù)后隨訪0.5~3y，評估治療效果。結(jié)果?DSA表現(xiàn)為支氣管動脈-肺動脈瘺和支氣管動脈-肺靜脈瘺者分別為15例和6例，同時合并肋間動脈-肺循環(huán)瘺者

2、5例。其中17例經(jīng)支氣管動脈栓塞后達(dá)到即刻止血效果，有3例栓塞術(shù)后咯血量明顯減少，經(jīng)保守治療后痊愈出院?？傆行蕿?5.2%。另1例因肋間動脈和鎖骨下動脈參與供血，未能有效止血，在介入術(shù)后6h轉(zhuǎn)胸外科手術(shù)治療。經(jīng)隨訪發(fā)現(xiàn)，有2例分別在介入栓塞后4m和11m復(fù)發(fā)，5例在19m內(nèi)死于肺癌合并癥。結(jié)論?支氣管動脈-肺循環(huán)瘺在咯血病人中是常見的血管異常，可加重咯血和心肺疾病的進(jìn)展，經(jīng)皮穿刺支氣管動脈栓塞術(shù)是有效的治療方法?！娟P(guān)鍵詞】咯血；支氣管動脈；栓塞，治療性；治療結(jié)果The?DSA?findingsandtheinterventionaltherapyexperien

3、ceofbronchialarterytopulmonarycirculationshunt.?LVWei-fu*,ZHANGXing-ming,ZHANGXue-bin,ZHANGZhen-feng,HOUChang-long,HUShu-dong.*DepartmentofRadiology,AnhuiProvincialHospital,Hefei230001,China?【Abstract】?Objective?Toanalysisthe?DSAfindingsandinterventionaltherapyexperienceofbronchialart

4、erytopulmonarycirculationshunt(BPS).?Methods?BPSwereconfirmedbyDSAin21patientswithhemoptysis.Thedisordervesselswereembolizedusingvariouskindsandsizesembolismparticleswithaccordingtotheshunttipeandnumber,theshuntorificesizeandcirculationtime.In6patientswithin1seccirculation?time,theshu

5、ntorificeswere?pre-embolizedusinggelfoamparticles,and5-0silksegmentsmeasuringabout1mmwereusedforcompensativeembolism.Theremaining15patientsbeyong1seccirculationtimewereembolizedonlyusingsilksegments.Results?AccordingtoDSAfindings,bronchialarterytopulmonaryarteryshuntandbronchialartery

6、topulmonaryveinshuntwereconfirmedin15and6patients,respectively.Amongthem,17patientsstopbleedinginstantlyafterembolization,andthebleedingdecreasedsignificantlyinthe3patients.The?totaleffectiveratewas95.2%。Theremainingonewasinefficiencyduetothebloodsupplycomingfromintercostalarteriesand

7、subclavianartery,whowasperformedbysurgicalintervention6hoursafterembolization.Thefollowing-uprevealedthathemoptysisre-occurredin2patients4monthsand11monthsrespectivelyafterembolizationand5patientsdiedduetopulmonarycancerwithin19months.?Conclusion??BPSisacommonvesselabnormalityinthepat

8、ients