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  • 葛 韬,徐欣楠,张 鹏,等.支气管动脉栓塞术联合肺切除术治疗支气管扩张大咯血临床分析[J].同济大学学报(医学版),2020,41(4):449-453.    [点击复制]
  • GE Tao,XU Xin-nan,ZHANG Peng,et al.Clinical analysis of bronchial arterial embolization combined with lung resection in treatment of bronchiectasis with massive hemoptysis[J].同济大学学报(医学版),2020,41(4):449-453.   [点击复制]
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支气管动脉栓塞术联合肺切除术治疗支气管扩张大咯血临床分析
葛韬,徐欣楠,张鹏,姜格宁,姜思明
0
(苏州大学医学部,江苏 苏州 215123;同济大学附属上海市肺科医院胸外科,上海 200433)
摘要:
目的 评估经导管支气管动脉栓塞术(bronchial arterial embolization, BAE)联合肺切除术治疗支气管扩张大咯血的安全性和有效性。方法 回顾性分析2013年1月—2018年2月在同济大学附属上海市肺科医院接受BAE联合肺切除术治疗的21例支气管扩张大咯血患者的临床资料。结果 单纯咯血为主要症状者12例(57.1%),咯血合并反复感染症状者9例(42.9%)。15例(71.4%)患者BAE治疗后复发咯血,其中3例(20%)患者复发大咯血需紧急手术。术后并发症发生率38.1%,1例患者出现脓胸。术前合并反复感染症状者,术后并发症发生率显著高于单纯咯血患者(66.7% vs 16.7%,P=0.032);既往肺结核病史和支扩伴毁损肺不是术后并发症发生的高危因素。20例(95.2%)患者术后随访期间未复发咯血,仅1例(4.8%)患者偶发轻度咯血症状。结论 BAE 联合肺切除术治疗支气管扩张症大咯血安全、可行,能够改善患者的远期疗效。术前合并反复感染症状者,术后并发症发生率较高。
关键词:  支气管扩张  手术  支气管动脉栓塞术  大咯血  毁损肺
DOI:10.16118/j.1008-0392.2020.04.008
投稿时间:2020-01-10
基金项目:上海市科学技术委员会学术带头人计划(19XD1423200)
Clinical analysis of bronchial arterial embolization combined with lung resection in treatment of bronchiectasis with massive hemoptysis
GE Tao,XU Xin-nan,ZHANG Peng,JIANG Ge-ning,JIANG Si-ming
(Medical College of Soochow University, Suzhou 215123, China;Dept. of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China)
Abstract:
Objective To evaluate the safety and efficacy of bronchial arterial embolization(BAE) combined with lung resection for bronchiectasis patients with massive hemoptysis. Methods The clinical data of 21 bronchiectasis patients with massive hemoptysis who received BAE combined with lung resection in Shanghai Pulmonary Hospital from January 2013 to February 2018 were retrospectively analyzed. Results Twelve patients (57.1%) with hemoptysis as the main symptom, and 9 patients with hemoptysis and repeated infection (42.9%). Fifteen patients (71.4%) had recurrent hemoptysis after BAE, of whom 3 (20.0%) underwent urgent surgery. The incidence of postoperative complications was 38.1%, and empyema developed in 1 case. The incidence of complications was significantly higher in patients with hemoptysis and recurrent infections than that in patients with hemoptysis alone (66.7% vs 16.7%, P=0.032). The incidence of complications was not significantly increased in patients with history of tuberculosis and in patients with bronchiectasis-induced lung damage. During the follow-up, 20 patients (95.2%) had no recurrent hemoptysis, and only 1 patient (4.8%) with incomplete resection had residual mild hemoptysis. Conclusion BAE combined with lung resection for bronchiectasis with massive hemoptysis is safe and feasible,which can improve the long-term efficacy of patients. Patients with repeated infections have a higher risk of postoperative complications.
Key words:  bronchiectasis  surgery  bronchial arterial embolization  massive hemoptysis  destroyed lung

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