Ramakantan R, Bandekar V G, Gandhi M S, Aulakh B G, Deshmukh H L
Department of Radiology, King Edward Memorial Hospital, Parel, Bombay, India.
Radiology. 1996 Sep;200(3):691-4. doi: 10.1148/radiology.200.3.8756916.
To determine the efficacy of bronchial artery embolization in the control of massive hemoptysis due to pulmonary tuberculosis.
Between 1988 and 1994, 140 patients (125 men and 15 women; mean age, 31.5 years) who presented with massive hemoptysis (more than 300 mL of blood in 24 hours) underwent bronchial artery embolization. Fifty-one patients had received no antituberculosis drugs. Bronchial artery embolization was performed on the side with the greater abnormality on the chest radiograph. Catheters (4 F) and a gelatin sponge were used for embolization. Inflammatory hypervascularity was seen in all patients (five patients had contrast material extravasation and 10 patients had pseudoaneurysms).
Almost complete control of hemoptysis was achieved in 102 patients. Of the remaining 38 patients with a notable amount of bleeding after the procedure, 29 were treated successfully with conservative measures and nine underwent re-embolization. Seven patients who underwent re-embolization had recurrent bleeding; four of these patients underwent successful surgery, and three died of aspiration. Two patients developed transient paraparesis 6 hours after the procedure. Nine patients reported transient referred pain to the ipsilateral orbit during injection of the gelatin sponge. One patient had transient dysphagia.
Patients with massive hemoptysis due to pulmonary tuberculosis should first be treated with bronchial artery embolization.
确定支气管动脉栓塞术在控制肺结核所致大咯血方面的疗效。
1988年至1994年间，140例出现大咯血（24小时内咯血超过300毫升）的患者（125例男性和15例女性；平均年龄31.5岁）接受了支气管动脉栓塞术。51例患者未接受过抗结核药物治疗。根据胸部X线片上异常较明显的一侧进行支气管动脉栓塞术。使用4F导管和明胶海绵进行栓塞。所有患者均可见炎症性血管增多（5例有对比剂外渗，10例有假性动脉瘤）。
102例患者的咯血几乎完全得到控制。其余38例术后仍有大量出血的患者中，29例经保守治疗成功，9例接受了再次栓塞。接受再次栓塞的7例患者出现复发出血；其中4例患者手术成功，3例死于误吸。2例患者术后6小时出现短暂性截瘫。9例患者在注射明胶海绵时报告同侧眼眶出现短暂性牵涉痛。1例患者出现短暂性吞咽困难。
肺结核所致大咯血患者应首先接受支气管动脉栓塞术治疗。
