支气管动脉栓塞治疗肺结核咯血的疗效及复发原因分析

摘要

目的 探讨支气管动脉栓塞(BAE)治疗肺结核咯血的临床疗效及复发原因,旨在提高治疗效果.方法 2007年10月至2010年9月选择因肺结核并发反复咯血和大咯血患者39例,其中浸润性肺结核28例,慢性纤维空洞性肺结核11例.采用单纯聚乙烯醇(PVA)颗粒栓塞14例,PVA颗粒加弹簧圈双重栓塞25例,随访12 ～ 48个月.结果 即刻止血36例,即刻止血率92.3%,显效3例.其中一次性栓塞治愈或显效30例,治愈率76.9%;复发9例,复发率23.1%.PVA颗粒与PVA颗粒加弹簧圈双重栓塞间复发率差异有统计学意义(42.9% 比12.0%,P ＜ 0.05).慢性纤维空洞性肺结核患者咯血复发率高于浸润性肺结核患者(45.5%比14.3%,P ＜ 0.05).结论 BAE具有止血快、疗效好等优点,已成为肺结核咯血的首选治疗手段.采用双重栓塞可有效降低肺结核咯血的复发率.%Objective To investigate clinical effect of bronchial artery embolization (BAE) in treating massive hemoptysis due to pulmonary tuberculosis and to analyze the causes of recurrence in order to improve the therapeutic results. Methods A total of 39 cases of patients with recurrent massive hemoptysis due to pulmonary tuberculosis, who were encountered during the period from Oct. 2007 to Sep. 2010, were enrolled in this study. The lesions included infiltrative pulmonary tuberculosis (re. = 28) and chronic fibrocavitary pulmonary tuberculosis (re = 11). BAE with polyvinyl alcohol (PVA) particles only was performed in 14 cases (group A), while BAE with both PVA particles and coils was carried out in 25 cases (group B). All the patients were followed up for 12 ~ 48 months. The results were compared between the two groups. Results Immediate hemostasis was obtained in 36 cases (92.3%), the clinical result was excellent in 3 cases. The complete cure or excellent result with single embolization procedure was achieved in 30 cases (76.9%). Recurrence was seen in 9 cases (23.1%). The difference in the recurrence rate between group A (42.9%) and group B (12.0%) was statistically significant (P < 0.05). The relapsing rate of patients with chronic fibrocavitary pulmonary tuberculosis was significantly higher than that of patients with infiltrative pulmonary tuberculosis (45.5% vs. 14.3%, P < 0.05). Conclusion BAE has an instant effect of hemostasis and satisfactory clinical result. Nowadays BAE has already become the treatment of first choice for hemoptysis caused by pulmonary tuberculosis. The dual embolization technique with the combination use of PVA particles and coils can effectively reduce the recurrence of pulmonary tuberculosis hemoptysis.(J Intervent Radiol, 2012, 21: 414-417)