不同介入治疗方法对大咯血临床疗效观察.docVIP

不同介入治疗方法对大咯血临床疗效观察【中图分类号】R563.6；R815 【文献标识码】A【文章编号】1003-8183-（2011)09-0001-03【摘要】目的：评价大咯血不同血供方式、栓塞方法的疗效及复发因素分析。方法：收集60例大咯血患者行超选择性插管栓塞出血动脉，将供血方式分为单支动脉供血（20例）和多支动脉供血（40例）两组，按栓塞方法分为单纯明胶海绵栓塞（26例）、单纯PVA颗粒栓塞（12例）、PVA颗粒加明胶海绵栓塞（22例）三组，评价各组的疗效。结果：60例患者行介入栓塞治疗后咯血均完全停止，技术成功率率为100%。随访2mo～3a，17例患者复发，总体有效率为71.67%；其中单支动脉供血2例复发，有效率为90%；多支动脉供血15例复发，有效率为62.5%；单纯明胶海绵组11例复发，有效率为57.7%；单纯PVA颗粒组2例复发有效率为83.3%；PVA颗粒加明胶海绵组4例复发，有效率为81.8%，有效率存在显著差异（P＜0.05）。结论：单纯明胶海绵栓和多支动脉供血更容易导致介入栓塞治疗后复发；单纯PVA、PVA加明胶海绵栓塞后疗效较好 【关键词】大咯血；介入治疗；疗效观察 Different Intervention meThods on the Clinical Efficacy of Massive Hemoptysis Luo Xihua 【Abstract】Objective：To evaluation the interventional therapy in hemoptysis of different bloodsupply，the effect of embolization method and recurrent factors.Mehtods： 60 patients of hemoptysis with embolized bleeding artery with super-selective incubation.The blood supply of patients will be divided into simple arteries feeding and multi-branch artery two groups.Based on the agents of embolization，all the patients will be divided into gelfoam group，PVA group，PVA and gelfoam.Results： 60 cases of patients with embolization were completed cessation of hemoptysis，and technical successful rate was 100%.Followed-up 1～3 years，17 patients relapsed， the overall effective rate was 71.67%.The embolization with Gelfoam only is in the most possibility of recurrent.The overall effective rate of simple arteries group was 90%.The overall effective rate of multi-branch artery group was 62.5%. Conclusion： The embolization with PVA or Gelfoam and PVA is a effective procedure for hemoptysis.The embolic agent with Gelfoam only and the patients with multi blood supply to dieased region dose not have a satisfactory outcome. 【Key words】 Hemoptysis；Interventional therapy；Curative effect observation 大咯血有着多种的发病原因，例如支气管扩张、肺结核、肺癌、肺血管病变等[1-3]，随着社会的发展，肺部疾病呈现一种增长的趋势，因此大咯血也成为一种常见的、多发的疾病[4]。各种肺部的疾病所致的顽固性大咯血是临床中常见的症状，大咯血容易反复发生，难以提高疗效[5]，是长期以来一直困扰临床医师的一个问题。目前大咯血的治疗包括内科对症治疗，外科手术切除，支气管镜药物治疗及介入的血管栓塞治疗等。随着介入方法及