Renaud S, Falcoz P-E, Santelmo N, Massard G
Service de chirurgie thoracique, nouvel hôpital civil, 1 place de l'Hôpital, Strasbourg, France.
Rev Pneumol Clin. 2012 Apr;68(2):123-30. doi: 10.1016/j.pneumo.2012.01.005. Epub 2012 Mar 2.
Massive hemoptyses are serious clinical conditions that can quickly jeopardize the vital prognosis. The major risk is asphyxiation, due to the bleeding into the tracheobronchial tree. The clinician should provide in parallel support for diagnosis and treatment, locating the bleeding but also finding its cause. Such patients should be cared for by a multidisciplinary team, having quick access to an important technical support. The association fiberoptic bronchoscopy-chest CT scan seems to be the most effective to locate and identify the cause of the bleeding. The development of bronchial artery embolization has revolutionized the management of these patients, replacing surgery in many of its indications. The latter still keeps a place in the management of these patients. Indeed, it is the main etiological treatment, preventing the vast majority of recidivism. It is absolutely indicated in the treatment of bleeding from the pulmonary vessels, and in case of failure of other techniques. It should be performed whenever possible away from the episode of hemoptysis, in order to minimize the operative risk.
大量咯血是严重的临床病症，可迅速危及生命预后。主要风险是窒息，这是由于血液流入气管支气管树所致。临床医生应同时提供诊断和治疗支持，既要确定出血部位，也要找出出血原因。此类患者应由多学科团队护理，并能迅速获得重要的技术支持。纤维支气管镜检查与胸部CT扫描相结合似乎是定位和确定出血原因最有效的方法。支气管动脉栓塞术的发展彻底改变了这些患者的治疗方式，在许多适应症上取代了手术治疗。手术治疗在这些患者的治疗中仍占有一席之地。实际上，它是主要的病因治疗方法，可预防绝大多数复发情况。在治疗肺血管出血以及其他技术治疗失败时，绝对需要进行手术。只要有可能，手术应在咯血发作期之外进行，以尽量降低手术风险。
