【摘要】 目的探讨咯血病灶的多支血供特点,以及应用明胶海绵栓塞供血动脉治疗顽固性咯血的临床价值。方法128例内科治疗无效的咯血患者,包括支气管扩张70例,肺结核23例,肺癌27例,肺隔离症2例,真菌感染2例,外伤1例,胸部术后3例。采用Seldinger技术行股动脉穿刺,将导管插至胸主动脉和锁骨下动脉,探查病灶供血动脉,并行数字减影血管造影(DSA)。针对供血动脉用明胶海绵进行栓塞。所有病例均随访6月以上。将具有2支或2支以上病灶供血动脉的病例作为统计对象。结果89例存在病灶多支血供,占69.5%(89/128),总共233支多支供血动脉中包括支气管动脉157支,肋间动脉54支,胸廓内动脉18支,甲状颈干2支,迷走供血动脉2支。上述动脉呈不同程度增粗。除2例支气管扩张和1例肺癌外,其余86例栓塞后咯血症状改善,有效率96.6%(86/89),其中15例复发,复发率为17.4%(15/86)。无严重的栓塞后并发症出现。结论部分咯血患者的病灶具有多支动脉供血,栓塞前全面探查病灶供血动脉是必要的;针对病灶的多支供血动脉栓塞是治疗顽固性咯血的一种安全、有效的方法。更多还原

【Abstract】 Objective To study the features of multiple blood supply of hemoptysis,and to explore the clinical value of transarterial embolization with gelfoam for treatment the refractory hemoptysis.Methods There were 128 cases with hemoptysis failed to medicine treatment including 70 cases of bronchiectasis, 23 cases of tuberculosis, 27 cases of lung cancer, 2 cases of pulmonary sequestration , 2 cases of fungus infection, 1 case of trauma and 3 cases after thoracic operation in this study. By using Seldinger technique, with the tip of the catheter located in thoracic aorta and subclavian artery , the feeding arteries of the focus were defined by digital subtraction angiography (DSA) and embolized with gelfoam via femoral artery. All cases were followed up for more than six months. The cases having more than one feeding artery of the focus were analysed.Results 89 cases with multiple blood supply of the focus, accounted for 69.5%(89/128). There were 157 bronchial arteries, 54 intercostal arteries, 18 internal thoracic arteries, 2 thyrocervical trunks and 2 aberrant nominate arteries in all the 233 multiple feeding arteries,which were thickened in various degree. Except for 2 cases of bronchiectasis and 1 case of lung cancer , 86 cases increasingly improved after embolization, the effective rate was 96.6%(86/89).15 cases recured, the recurrent rate was 17.4%(15/86). No serious complications occurred.Conclusion A part of cases with hemoptysis have multiple blood supply of the focus .It was essential to detect all the feeding arteries of the focus; the feeding artery embolization with gelfoam is a more safe and effective way in treating the refractory hemoptysis.更多还原