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Efficacy of Bronchial Arterial Embolization in Treatment of Massive Hemoptysis due to Bronchiectasis: 205 Cases Analysis

Objective To evaluate the clinical effects of bronchial artery embolization ( BAE) for massive hemoptysis due to bronchiectasis.Methods 205 patients with massive hemoptysis were treated with bronchial artery embolization using coils, polyvinyl alcohol ( PVA) microspheres, line segmen, and gelatin sponge after the site of bleeding or the abnormal arteries were identified by arteriography. Super selective bronchial artery embolization was performed with a coaxial microcatheter inserted into the bronchial artery. Results BAE was successfully performed in 205 cases with massive hemoptysis ( left and right bronchial artery embolization in 35 cases, left bronchial artery embolization in 20 cases, right bronchial artery embolization in 126 cases, common bronchial artery embolization in 22 cases, right inferior phrenic artery embolization in 2 cases) . Of 205 patients, 169 were cured, 24 were relieved with a success rate of 94.1% . Long termcumulative hemoptysis nonrecurrence rates was 82.4% . 23 patients developed post embolization syndrome characterized by mild fever and chest pain and ended with spontaneous recovery without special management. No severe complications including spinal cord injury or dystopia embolization were observed. Conclusions Bronchial arterial embolization interventional therapy is a rapid, safe and effective method in the treatment of massive hemoptysis due to bronchiectasis.

Clinical comparison of pulmonary lobectomy in patients with massive hemoptysis of pulmonary tuberculosis after bronchial artery embolization

ObjectiveTo compare the clinical data of pulmonary lobectomy in patients with massive hemoptysis of pulmonary tuberculosis after bronchial artery embolization in the short and long term, so as to provide a reference for clinical choices of appropriate operation time.MethodsA retrospective analysis was conducted on 33 patients with massive hemoptysis of pulmonary tuberculosis, who had received pulmonary lobectomy after bronchial artery embolization in Wuhan Pulmonary Hospital from January 2015 to November 2017, including 29 males and 4 females aged of 23-66 (52.64±9.70) years. According to the time interval between bronchial artery embolization and lobectomy, the patients were divided into a short-term group (<2 weeks, 14 patients) and a long-term group (>1 month, 19 patients). The clinical data, such as operation time, intraoperative blood loss, postoperative extubation time and serious postoperative complications, were observed in the two groups for statistical analysis.ResultsThe operative time (297.13±75.69 min vs. 231.32±67.57 min, P=0.013), intraoperative blood loss (685.74±325.51 mL vs. 355.83±259.11 mL, P=0.002), postoperative extubation time (14.07±5.24 d vs. 8.90±3.57 d, P=0.003) of the short-term group were all higher than those in the long-term group.ConclusionFor the patients with massive hemoptysis of pulmonary tuberculosis, who had surgical indications and no risk of early rebleeding after bronchial artery embolization, pulmonary lobectomy should be performed late until the patient's physical condition and the primary disease was stable.

支气管镜联合胸腔镜手术治疗大咯血32例临床体会

目的探讨支气管镜联合胸腔镜手术治疗大咯血的可行性、安全性和有效性。 方法回顾性分析九江市第一人民医院胸外科自2009年5月至2013年4月完成的32例经支气管镜联合胸腔镜手术治疗大咯血患者的临床资料。其中男19例、女13例，年龄24～60（40.2±9.1）岁；因支气管扩张致大咯血24例，肺癌合并咯血6例，肺结核咯血2例。 结果2例（6%）因胸腔粘连严重而中转开胸。1例因气管内出血量大，纤维支气管镜无法准确定位，终止手术，最终死亡。余29例在全胸腔镜下完成肺叶切除术，包括右肺上叶切除4例，右肺下叶12例，左肺下叶10例，左肺上叶3例。其中6例术中冰冻病理检查提示癌，加做淋巴结清扫术；1例右肺上叶支气管扩张行右肺上叶切除术后第3 d再次出现大咯血，手术证实为右肺中叶再次出血，行右肺中叶切除术；其余22例术后均无咯血。 结论支气管镜联合胸腔镜手术治疗大咯血是一种安全有效的方法。

支气管扩张症138例

目的 总结支气管扩张症外科治疗的临床诊断和治疗经验. 方法 回顾性分析1985～ 1999年手术治疗138例支气管扩张症患者的诊断和治疗情况. 结果 全组无1例手术死亡,94例单叶或双叶支气管扩张患者症状消失;13例双侧或广泛支气管扩张患者,症状均改善. 结论 把握好手术适应证和肺的切除范围,可降低手术死亡率和并发症发生率,提高治疗效果.肺切除术对治疗单叶或双叶支气管扩张疗效十分显著,尽可能完全切除病灶是获得最佳治疗效果的前提.

Therapeutic Evaluation of Selective Bronchial Artery Embolization in Massive Hemoptysis of Bronchiectasis

目的:对选择性支气管动脉栓塞术(SBAE) 治疗支气管扩张大咯血的疗效做客观评价,并就该技术的操作要点、注意事项等诸方面的技术问题做进一步探讨总结。方法:对32例内科保守治疗无危急生命的支气管扩张大咯血患者行介入法供血支气管动脉栓塞, 其中男18例, 女14例, 平均年龄46岁.结果:所有病例都成功实施了供血动脉栓塞, 术后除1例无效外均出血停止, 无严重并发症发生。结论:SBAE作为治疗支气管扩张大咯血的急救手段之一,具有创伤轻微、可重复性强、疗效高、见效快、并发症少、简便易行等特点,极具推广应用价值。

支气管Dieulafoy 病致大咯血一例

病历摘要 患者男性, 62 岁。因“咯血3 d, 加重1 h”于2010 年3 月23 日凌晨急诊入院。患者于入院3 d 前无诱因出现咯血, 初咯血量较少, 入院前1 h 突然出现大咯血, 鲜红色, 约150 mL; 伴头晕、心悸, 无畏寒、发热, 无胸痛和呼吸困难。既往有两次大咯血病史, 未明确诊断; 否认肺结核和支气管扩张病史。

Embosphere 微粒球栓塞大咯血出血靶血管的疗效和安全性研究

目的 观察 Embosphere 微粒球作为栓塞材料治疗大咯血的近远期疗效和安全性。 方法 纳入 2013 年 7 月至 2016 年 3 月收治的 82 例大咯血患者，采用 Embosphere 微粒球为主要的栓塞材料，栓塞支气管动脉以及其他出血靶血管，观察 24 h 内咯血有无停止，7 d 内有无咯血反复，以及围手术期的不良反应。术后随访 1 年观察咯血有无反复。 结果 患者术后 24 h 内咯血停止 78 例，明显减少 3 例，无效 1 例；7 d 内有 1 例出现反复。近期有效率 97.6%（80/82）。随访 1 年，咯血复发 4 例，远期有效率 92.7%（76/82）。围手术期的不良反应主要为胸痛、胸闷和发热，未发生严重并发症。 结论 Embosphere 微粒球经出血靶血管栓塞治疗大咯血的近期和中远期疗效确切，无严重的不良反应，值得临床推广应用。

Coopdech 支气管封堵器在抢救大咯血窒息中的应用

目的 探讨Coopdech支气管封堵器用于大咯血窒息抢救的可行性及疗效。方法 在患者发生大咯血窒息时, 特别是无条件行双腔支气管插管或双腔支气管插管困难时, 在支气管镜引导下对2 例患者置入Coopdech 支气管封堵器。结果 2 例大咯血患者Coopdech 支气管封堵器置入后, 1 例保守治疗成功,1 例为支气管动脉栓塞术赢得时间。结论 Coopdech 支气管封堵器可以有效替代双腔支气管导管用于抢救大咯血患者, 值得进一步临床应用。

巨大甲状腺血管肉瘤合并咯血患者的气道管理

以发热并发气促、咯血为表现的鹦鹉热衣原体肺炎一例报告并文献复习

目的 总结鹦鹉热衣原体感染的临床特征，探讨鹦鹉热衣原体感染出现咯血的发生机制及治疗手段，提高临床对本病的认识。方法 报道国内首例经支气管镜冷冻技术治疗鹦鹉热衣原体感染出现咯血患者的诊疗经过，并回顾国内外数据库建库至今，筛选及总结分析鹦鹉热衣原体感染导致咯血的文献报道。结果 患者为38岁女性，以发热并发气促、咯血为主要表现，经肺泡灌洗液宏基因组二代测序（metagenomics next-generation sequencing，mNGS）检测诊断为鹦鹉热衣原体肺炎。通过药物对症处理以及经支气管镜冷冻治疗后病情好转。结合相关文献和该病例，共10例患者因鹦鹉热衣原体感染出现咯血的表现。结论 鹦鹉热衣原体感染早期临床表现无特异性，临床问诊需追溯鸟类及家禽接触史，mNGS能较为精准鉴定病原体。现鹦鹉热衣原体感染治疗首选四环素类药物，大环内酯类及喹诺酮类抗生素也有效。本例通过支气管镜冷冻技术治疗后病情好转，为临床治疗鹦鹉热衣原体感染出现咯血提供经验参考，但关于发生机制及其他诊疗思路仍值得深入研究。