75438 Department of Interventional Pulmonolgy, Apollo Hospitals, Bengaluru, Karnataka, India.
Innovations (Phila). 2020 Mar/Apr;15(2):142-147. doi: 10.1177/1556984520904351.
Massive hemoptysis (MH) has a high mortality rate. Therapeutic options include bronchoscopy for endobronchial lesions, bronchial artery embolization (BAE), and emergency surgery. Scant options exist for patients who are not candidates for these modalities. Culprit bronchial segment occlusion is an option to prevent "spillover flooding → hypoxia." Applying this concept, we describe a case series of MH control using a novel bronchoscopically inserted customized endobronchial silicone blocker (CESB). We analyzed the safety and efficacy of CESBs in a select subset of patients with MH.
Inclusion criteria were patients with MH who were unstable for surgery/BAE, failed BAE, or relatively contraindicated/refused BAE. CESBs were manufactured on-site by modifying silicone stents, inserted using rigid bronchoscopy and reinforced with glue. The CESB was removed after 6 weeks when possible. A successful outcome was defined as immediate bleeding control with no recurrence after removal.
Over 4.5 years, 13 episodes of MH in 12 patients meeting the criteria specified earlier were treated with CESBs. Seven of 12 patients had tuberculosis, 4 active and 3 inactive. One patient had mucormycosis, 1 post-lobectomy, 1 endobronchial renal cell carcinoma, 1 fibrosing mediastinitis, and 1 patient had metastatic laryngeal Ca. Eight of 12 patients were taken for placement. Four of 12 patients were sent for BAE, which was unsuccessful, and was done for definitive management. The success rate, as defined earlier, was 92.3%, with no deaths from MH.
Innovative bronchoscopically inserted CESBs are an effective strategy in MH when patients are unstable or fail conventional management.
大咯血（MH）死亡率高。治疗选择包括支气管镜检查治疗支气管内病变、支气管动脉栓塞（BAE）和急诊手术。对于不符合这些治疗方式的患者，选择有限。责任支气管段闭塞是防止“溢出性洪水→缺氧”的一种选择。应用这一概念，我们描述了一组使用新型支气管镜插入定制支气管内硅酮阻塞器（CESB）控制 MH 的病例系列。我们分析了 CESB 在一组 MH 不稳定患者中的安全性和疗效。
纳入标准为手术/BAE 不稳定、BAE 失败或相对禁忌/拒绝 BAE 的 MH 患者。通过修改硅酮支架现场制造 CESB，使用硬支气管镜插入，并使用胶水加固。当可能时，在 6 周后取出 CESB。成功结果定义为立即止血，取出后无复发。
在 4.5 年期间，12 例符合上述标准的患者中有 13 例 MH 发作，采用 CESB 治疗。12 例患者中有 7 例为肺结核，4 例为活动性肺结核，3 例为陈旧性肺结核。1 例为毛霉菌病，1 例为肺叶切除术后，1 例为支气管内肾细胞癌，1 例为纤维性纵隔炎，1 例为转移性喉癌。12 例中有 8 例为置入。12 例中有 4 例因 BAE 失败而被送往 BAE，后行确定性治疗。如前所述，成功率为 92.3%，无 MH 死亡。
在患者不稳定或常规治疗失败时，创新的支气管镜插入 CESB 是 MH 的有效策略。
