Miyano Yutaka, Kanzaki Masato, Onuki Takamasa
1 Department of Surgery I, Tokyo Women's Medical University, Tokyo, Japan.
2 Department of Thoracic Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
Asian Cardiovasc Thorac Ann. 2017 Nov;25(9):618-622. doi: 10.1177/0218492316667231. Epub 2017 Oct 26.
Background Today, treatment for hemoptysis is not limited to surgery, and among the various options, bronchial artery embolization is regarded as an effective approach. Methods In this retrospective study, 179 of 389 patients with massive hemoptysis were treated with bronchial artery embolization, without taking into account the underlying pathological lesions responsible (bronchiectasis in 41, aspergilloma in 29, lung cancer in 25, old tuberculosis in 23, pyothorax in 19, others in 23). Results Bronchial artery embolization failed in 12 cases. In the 167 successful cases, surgery was required in 16 and bronchial occlusion was performed in 4; 3 patients died due to recurrent massive hemoptysis. After bronchial artery embolization, thoracic surgery for reasons other than hemostasis was carried out in 15 patients. Bronchial artery embolization was performed in 31 patients with hemoptysis who had a history of chest surgery. Four patients underwent bronchial occlusion, and immediate hemostasis was achieved in all of them. Conclusions For treatment of hemoptysis, bronchial artery embolization is a safe and minimally invasive technique that can be performed repeatedly, and provides not only short-term but also prolonged effectiveness; thus it can be used as a first-line treatment irrespective of the underlying pathological lesion. Bronchial occlusion may be useful for emergency hemostasis, but it warrants careful follow-up with consideration of additional elective treatment such as bronchial artery embolization.
背景 如今，咯血的治疗方法并不局限于手术，在各种治疗选择中，支气管动脉栓塞术被视为一种有效的治疗方法。方法 在这项回顾性研究中，389例大量咯血患者中的179例接受了支气管动脉栓塞术治疗，未考虑潜在的病理病变（支气管扩张41例、曲霉菌球29例、肺癌25例、陈旧性肺结核23例、脓胸19例、其他23例）。结果 支气管动脉栓塞术失败12例。在167例成功病例中，16例需要手术治疗，4例进行了支气管封堵；3例患者因反复大量咯血死亡。支气管动脉栓塞术后，15例患者因止血以外的原因接受了胸外科手术。31例有胸部手术史的咯血患者接受了支气管动脉栓塞术。4例患者进行了支气管封堵，均立即实现了止血。结论 对于咯血的治疗，支气管动脉栓塞术是一种安全且微创的技术，可重复进行，不仅提供短期疗效，还具有长期有效性；因此，无论潜在的病理病变如何，它都可作为一线治疗方法。支气管封堵术可能有助于紧急止血，但需要仔细随访，并考虑诸如支气管动脉栓塞术等额外的选择性治疗。
