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[支气管动脉双重栓塞术治疗肺结核咯血患者的远期疗效及相关因素]

[The long-term effect and associated factors of double embolization of bronchial artery in patients with lung tuberculosis and hemoptysis].

作者信息

Zhang Yan-bin, Xiao Hai-hao, Tang Chun-mei, Fang Dong-ming, Tan Shou-yong, Xu Dong-zhen, Li Yi-geng

机构信息

Department of Internal Medicine, Guangzhou Chest Hospital, Guangzhou 510095, China.

出版信息

Zhonghua Jie He He Hu Xi Za Zhi. 2004 Jul;27(7):442-5.

Abstract

OBJECTIVE

To investigate the long-term effect and the key factors associated with relapse of double embolization of bronchial artery in patients with lung tuberculosis and hemoptysis.

METHODS

Fifty patients with lung tuberculosis and hemoptysis receiving the radiography and double embolization of bronchial artery (BAG + BAE) had been followed up for two years. The causes for hemoptysis relapse was determined, followed by specific treatment, and the effect was evaluated. Among them, 37 were males, 13 females, with the age of 8-75 years (mean age 47.6 years).

RESULTS

The 2 year follow-up showed that the cure rate and the effective rate were 62% (31/50) and 94% (47/50) respectively. In a short term after embolization, hemoptysis relapsed in 9 cases, the major causes being active tuberculosis and secondary bronchiectasis complicated with infection. Other responsible factors included missed-embolization of bronchial artery and remaining blood supply from systemic circulation. In mid and long term follow-up, hemoptysis relapsed in 10 cases, the major causes being secondary pulmonary mycotic infection and recurrence of tuberculosis.

CONCLUSIONS

The long term result of double embolization of bronchial artery in patients with lung tuberculosis and hemoptysis was significant. It could prevent the danger from massive hemoptysis, and therefore allows the medical therapy for tuberculosis. Embolization of bronchial artery is effective for hemostasis, while etiologic therapy aimed at removing the infection leading to chronic inflammation is the cure for tuberculosis and hemoptysis.

摘要

目的

探讨肺结核咯血患者支气管动脉双重栓塞术的远期疗效及复发的相关关键因素。

方法

对50例接受支气管动脉造影及双重栓塞术(BAG + BAE)的肺结核咯血患者进行了为期两年的随访。确定咯血复发的原因,随后进行针对性治疗,并评估疗效。其中男性37例,女性13例,年龄8 - 75岁(平均年龄47.6岁)。

结果

2年随访结果显示,治愈率和有效率分别为62%(31/50)和94%(47/50)。栓塞术后短期内,9例咯血复发,主要原因是活动性肺结核及继发性支气管扩张合并感染。其他相关因素包括支气管动脉栓塞遗漏及体循环供血残留。在中长期随访中,10例咯血复发,主要原因是继发性肺部真菌感染及结核复发。

结论

肺结核咯血患者支气管动脉双重栓塞术的远期效果显著。它可以预防大咯血的危险,从而使肺结核的药物治疗得以进行。支气管动脉栓塞术对止血有效,而针对消除导致慢性炎症的感染的病因治疗是治愈肺结核和咯血的关键。

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