Sundset A, Haanaes O C, Enge I
Medisinsk avdeling, Aker sykehus, Oslo.
Tidsskr Nor Laegeforen. 1992 Sep 30;112(23):2958-62.
Bronchial artery embolization is an established treatment for massive and serious haemoptysis. We review etiology, pathogenesis and different treatment modalities of major haemoptysis, and discuss indications and outcome. Massive haemoptysis, defined as > 300 ml/24 hrs., is a rare condition with a high mortality rate (30-80%) if treated conservatively. We describe seven patients treated with bronchial artery embolization. Three patients had massive haemoptysis, and four patients were treated for recurrent and severe haemoptysis. Two patients had haemorrhage because of inactive tuberculosis, five had cystic fibrosis. All patients were successfully treated by embolization, one patient suffered recurrent haemoptysis after four weeks. The other patients have shown no further haemoptysis during the observation period (mean 20 months). No complications were observed other than the common, self-limited post-embolization syndrome (mild fever and chest pain). In patients with severely reduced lung function and progressive disease, recurrent haemoptysis of even smaller amounts might interfere with postural drainage and cause infections and deteriorate lung function. Bronchial artery embolization should be considered for these patients as well. Unless localized lesions can be cured through surgical resection, we consider bronchial artery embolization to be the treatment of choice.
支气管动脉栓塞术是治疗大量严重咯血的一种成熟方法。我们回顾了大咯血的病因、发病机制及不同的治疗方式，并讨论了其适应证和治疗结果。大量咯血定义为24小时内咯血量超过300毫升，是一种罕见疾病，保守治疗时死亡率较高（30% - 80%）。我们描述了7例接受支气管动脉栓塞术治疗的患者。其中3例为大量咯血，4例为复发性严重咯血。2例因静止期肺结核出血，5例患有囊性纤维化。所有患者均通过栓塞术成功治疗，1例患者在4周后出现复发性咯血。其他患者在观察期（平均20个月）内未再咯血。除了常见的、自限性的栓塞后综合征（低热和胸痛）外，未观察到其他并发症。对于肺功能严重减退和病情进展的患者，即使少量的复发性咯血也可能干扰体位引流，导致感染并使肺功能恶化。对于这些患者也应考虑支气管动脉栓塞术。除非局部病变可通过手术切除治愈，否则我们认为支气管动脉栓塞术是首选治疗方法。
