Brandes Johann C, Schmidt Eric, Yung Rex
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Thorac Oncol. 2008 Sep;3(9):1071-2. doi: 10.1097/JTO.0b013e318183af75.
Massive hemoptysis in patients with advanced thoracic malignancies can be difficult to manage. Frequently, the bleeding source is not amenable to either bronchial artery embolization or surgical resection. Isolation of the bleeding source by endobronchial tamponade is an alternative management option. This is commonly achieved by the use of double-lumen endotracheal tubes or the placement of endobronchial balloons. Although effective, these approaches are not permanent solutions and may require prolonged intubation. We describe here an alternative, novel approach to endobronchial tamponade that does not require prolonged mechanical ventilation. We present a case in which massive hemoptysis from a left lower lobe cavitary lung cancer was successfully tamponaded and ultimately stopped by the placement of 2 covered self-expanding bronchial stents, allowing the patient to be extubated and to undergo further palliative therapy. No recurrent episodes of hemoptysis occurred throughout the patient's lifetime.
晚期胸部恶性肿瘤患者的大量咯血可能难以处理。通常,出血源既不适合支气管动脉栓塞术,也不适合手术切除。通过支气管内填塞隔离出血源是一种可供选择的处理方法。这通常通过使用双腔气管导管或放置支气管内球囊来实现。尽管有效,但这些方法并非永久性解决方案,可能需要长时间插管。我们在此描述一种不需要长时间机械通气的支气管内填塞新方法。我们报告一例左下叶空洞性肺癌导致的大量咯血患者,通过放置2个覆膜自膨式支气管支架成功填塞并最终止血,患者得以拔管并接受进一步的姑息治疗。患者一生中未再发生咯血。