Peralta A Rolando, Chawla Mohit, Lee Robert P
Department of Medicine, Pulmonary Service, Section of Interventional Pulmonology, Memorial Sloan Kettering Cancer Center, New York, NY.
J Bronchology Interv Pulmonol. 2018 Jul;25(3):204-211. doi: 10.1097/LBR.0000000000000470.
Airway bleeding, either spontaneous or as a result of bronchoscopy, is associated with significant morbidity and mortality. Multiple bronchoscopic techniques are available to achieve complete hemostasis or as a bridge to definitive therapies.
We report our experience on the feasibility of endobronchial instillation of an absorbable gelatin and thrombin slurry (GTS) for the treatment of spontaneous hemoptysis and procedure-related bleeding.
We identified 13 cases in which GTS was used for endobronchial hemostasis when standard bronchoscopic measures like cold saline, epinephrine, and in some cases balloon occlusion were not successful. GTS was delivered through the working channel of the bronchoscope in 10 cases and through the distal port of a bronchial blocker in the remaining 3 cases. Median age was 69 years (range, 52 to 79 y). Eight cases corresponded to spontaneous hemoptysis and 5 cases to diagnostic or therapeutic procedures. Bleeding was considered severe in 9 (70%) cases. All but 1 case were associated with malignancy. Hemostasis was achieved in 10 (77%) cases by using standard measures in addition to GTS. No patient adverse events at 30 days or damage to the equipment were identified.
Bronchoscopic instillation of an absorbable GTS is feasible and may be used in cases of spontaneous or procedure-related bleeding in addition to conventional measures. It can be delivered through the working channel of the bronchoscope or through the distal port available in some bronchial blockers. Controlled studies are necessary to determine the safety and efficacy of this novel technique.
气道出血，无论是自发性的还是支气管镜检查导致的，都与显著的发病率和死亡率相关。有多种支气管镜技术可用于实现完全止血或作为确定性治疗的桥梁。
我们报告了经支气管内注入可吸收明胶和凝血酶浆液（GTS）治疗自发性咯血和与操作相关出血的可行性经验。
我们确定了13例患者，在使用冷盐水、肾上腺素等标准支气管镜措施，以及在某些情况下使用球囊封堵均未成功止血时，使用GTS进行支气管内止血。10例通过支气管镜工作通道注入GTS，其余3例通过支气管封堵器的远端端口注入。中位年龄为69岁（范围52至79岁）。8例为自发性咯血，5例为诊断或治疗操作相关出血。9例（70%）出血被认为严重。除1例患者外，所有患者均与恶性肿瘤相关。10例（77%）患者通过使用标准措施加GTS实现了止血。未发现30天内患者出现不良事件或设备损坏。
支气管镜下注入可吸收GTS是可行的，除常规措施外，可用于自发性或与操作相关的出血情况。它可通过支气管镜工作通道或某些支气管封堵器的远端端口注入。需要进行对照研究以确定这种新技术的安全性和有效性。
