应用海藻酸钠微球支气管动脉栓塞治疗大咯血的临床研究_医学论文.docVIP

应用海藻酸钠微球支气管动脉栓塞治疗大咯血的临床研究_医学论文 应用海藻酸钠微球支气管动脉栓塞治疗大咯血的临床研究_医学论文 【摘要】 目的 观察不同栓塞剂与栓塞效果及并发症的关系，探讨海藻酸钠微球(KMG)支气管动脉栓塞治疗大咯血的临床意义。方法 112例大咯血患者，行选择性或超选择性支气管动脉栓塞，单纯明胶海绵栓塞69例，含KMG微球栓塞26例，明胶海绵及金属弹簧圈双重栓塞17例。随访1～12个月，再次栓塞为复发病例。结果 即刻止血107例（95.5%），1年内复发16例。明胶海绵组复发率15.0%；含KMG组复发率7.7%；弹簧栓子组复发率17.6%；总复发率为14.3%3组间复发率差异无显著性（P＞0.05），但并发症差异有显著性(P＜0.05）。结论 合理的选用栓塞物质可明显降低咯血患者的复发率及并发症的发生率，KMG微球支气管动脉栓塞治疗大咯血安全、高效，能有效地减少复发率和并发症的发生。 【关键词】 海藻酸钠微球；支气管动脉栓塞；大咯血；放射学；治疗 【Abstract】 Objective To observe healing effect and complication by different embolism materials，and to study bronchial embolization with KMG in the massive hempotysis.Methods 112 patients with massive hemoptysis(85 males，27 females) were performed selective bronchial arteries embolization or superselective bronchial arteries embolization.69 cases were embolized with simple Gelfoam，26 cases were embolized with KMG and Gelfoam，17 cases were embolized with Gelfoam and platinum coils with Dacron fibres.All patients had been followed up for four to twelve months，with the second embolize if relapse.Results Immediate and complete control was achieved in 107 cases (95.5%)，hemoptysis decreased in 5 cases(4.5%).The effective rate was 100%，recurrence occurred in 16 cases (14.3%)，including 11 with simple Gelfoam，2 with KMG and Gelfoam，and 3 with Gelfoam particles and platinum coils with Dacron fibres.There exist significant difference in the complication of the three groups.Conclusion Reasonable choice of embolism agents are important in reducing recurrence and complications，and bronchial artery embolization with KMG is the more safe and effective method for the treatment of hemoptysis. 【Key words】 KMGbronchial artery embolizationmassive hemoptysisradiology therapeutic 咯血为呼吸系统疾病中较为常见的临床症状，其中大咯血占1.5%，需要及时治疗，但常规内科止血治疗效果有限，外科治疗又受诸多因素影响而不能及时实施，常对生命构成威胁，是造成呼吸道疾病突然死亡的原因之一。自1974年法国学者Remy［1］首先应用支气管动脉栓塞术（BAE）治疗大咯血成功至今，BAE治疗大咯血已取得满意的效果，死亡率明显下降，并得到临床的认可［2～4］。近年来介入栓塞治疗大咯血所用的栓塞剂多种多样［2～4］。海藻酸钠微球（KMG）作为一种新型的栓塞材料，在介入领域有其广泛的用途，本文采用选择性或同轴微导管超选择性支气管动脉栓塞技术，应