He Guanghui, Liu Wenyu, Gao Zhiqiang, Gao Zhi, Gao Hongsheng, Wang Yanjie
Department of Interventional Therapy, The Second People's Hospital of Weifang, Weifang, Shandong 261041, P.R. China.
Department of Tuberculosis, The Second People's Hospital of Weifang, Weifang, Shandong 261041, P.R. China.
Exp Ther Med. 2017 May;13(5):2259-2262. doi: 10.3892/etm.2017.4230. Epub 2017 Mar 15.
Retrospective analysis was carried out on intervention treatment and the effects of massive hemoptysis of pulmonary aspergilloma. Twenty-five cases diagnosed as massive hemoptysis of pulmonary aspergilloma were performed with imaging of bronchial arteries and other related blood vessels in order to assess blood vessel type and the number involved in the disease and perform embolotherapy on the offending artery. There were 68 bleeding arteries in 25 cases, of which there were 36 bronchial arteries (52.94%), 15 intercostal arteries (22.06%), 9 internal thoracic arteries (16.17%), 5 inferior phrenic arteries (7.35%), and 3 pulmonary arterial branches (4.41%) and all of them were in embolism condition. For 25 cases, 21 bleeding cases were stopped immediately (84.00%), 3 bleeding cases were stopped after the 2nd embolism, and 1 case had a small amount of hemoptysis after surgery discontinuously, which was stopped after corresponding treatment with no severe complications. Ten cases used polyvinyl alcohol (PVA) particulate embolization solely, 12 cases used PVA with spring coil and 3 cases used PVA, spring coil and -butyl cyanoacrylate (NBCA) glue. In conclusion, patients who suffer from massive hemoptysis of pulmonary aspergilloma and whose medical treatments are not effective and who are not willing to receive surgical removal, intervention treatment is an effective method. PVA, spring coil and NBCA glue can be effectively used in hemoptysis embolism and pulmonary artery embolism can be considered when systemic embolism is not effective.
对肺曲菌球大出血的介入治疗及效果进行回顾性分析。对25例诊断为肺曲菌球大出血的患者进行支气管动脉及其他相关血管成像,以评估血管类型及病变累及血管数量,并对责任动脉进行栓塞治疗。25例患者共有68条出血动脉,其中支气管动脉36条(52.94%)、肋间动脉15条(22.06%)、胸廓内动脉9条(16.17%)、膈下动脉5条(7.35%)、肺动脉分支3条(4.41%),均行栓塞处理。25例患者中,21例出血当即停止(84.00%),3例经第2次栓塞后出血停止,1例术后仍间断少量咯血,经相应处理后停止,无严重并发症发生。10例单纯采用聚乙烯醇(PVA)颗粒栓塞,12例采用PVA联合弹簧圈,3例采用PVA、弹簧圈联合氰基丙烯酸正丁酯(NBCA)胶。综上所述,对于肺曲菌球大出血且内科治疗无效又不愿接受手术切除的患者,介入治疗是一种有效的方法。PVA、弹簧圈及NBCA胶可有效用于咯血栓塞,全身栓塞无效时可考虑肺动脉栓塞。