逐級多重栓塞治療頑固性大咯血的技術(shù)探討和療效觀察
發(fā)布時間：2018-11-11 01:11
【摘要】：目的:探討個體化逐級多重栓塞治療頑固性大咯血的技術(shù)要點,對該栓塞方法的臨床療效進行評價,并分析體-肺循環(huán)分流的存在對術(shù)后療效的影響。方法:回顧性分析采用個體化逐級多重栓塞法治療的103例頑固性大咯血患者資料。通過造影明確責任血管的類型、數(shù)量、異常分支、肺循環(huán)和(或)肺周體循環(huán)分流情況后,結(jié)合疾病類型,以聚乙烯醇顆粒、海藻酸鈉微球作為基礎(chǔ)栓塞劑行個體化逐級多重栓塞治療。術(shù)后根據(jù)患者咯血癥狀的改善情況判定早期(術(shù)后3個月)、中期(術(shù)后3~6個月)和遠期(術(shù)后6個月)療效。采用Kaplan-Meier生存曲線對個體化逐級多重栓塞法治療頑固性大咯血的療效進行評價。根據(jù)責任血管供血特點將患者分為伴體-肺循環(huán)分流(SPS)組和無SPS組,并采用Log-Rank檢驗比較2組患者的有效率和有效時間。結(jié)果:103例患者共檢出責任血管215支,其中100例患者共196支行個體化逐級多重栓塞,8支行末梢栓塞治療,11支行主干明膠海綿顆粒栓塞。103例患者術(shù)后隨訪6~50個月,中位隨訪時間21個月。即刻止血率為97.1%(100/103)�；颊叩�1個月、3個月、6個月、1年、2年和3年的有效率分別為94.5%、93.2%、89.7%、88.9%、85.2%和76.6%。103例中,伴SPS組患者22例,無SPS組患者81例。伴SPS組和無SPS組患者的1年有效率分別為(69.5±0.11)%和(98.3±0.03)%;總有效率分別為55.6%和82.7%;中位有效時間分別為25(24.8±3.37)個月和42(42.2±1.50)個月。2組患者有效率和有效時間的差異均有統(tǒng)計學意義(2?=11.662,P0.01)。結(jié)論:根據(jù)責任血管的類型、數(shù)量、結(jié)構(gòu)、走形和溝通情況,采用個體化逐級多重栓塞法對責任血管進行夯實栓塞,不僅使咯血得到及時、有效的控制,而且可顯著降低由于責任血管再通、側(cè)枝循環(huán)建立所致的早期、中遠期復發(fā)率。但SPS的存在會影響該栓塞技術(shù)的臨床療效,所以造影過程中要注意查找SPS,并依據(jù)其結(jié)構(gòu)特點給予個案化栓塞,盡可能達到夯實栓塞效果、提高術(shù)后療效。
[Abstract]:Objective: to discuss the key points of individualized multiple embolization in the treatment of intractable massive hemoptysis, to evaluate the clinical effect of the embolization method and to analyze the influence of the presence of body-pulmonary circulation shunt on the postoperative outcome. Methods: the data of 103 patients with intractable hemoptysis were analyzed retrospectively. The type, quantity, abnormal branches, pulmonary circulation and / or peripulmonary circulation shunt of the responsible vessels were determined by angiography, combined with disease types, to polyvinyl alcohol granules, Sodium alginate microspheres were used as the basic embolization agent for individualized multilevel embolization. According to the improvement of hemoptysis symptoms, the early (3 months), the middle (3 ~ 6 months) and the long term (6 months after operation) were evaluated. The Kaplan-Meier survival curve was used to evaluate the efficacy of individualized multiple embolization in the treatment of intractable massive hemoptysis. According to the characteristics of responsible blood supply, patients were divided into two groups: (SPS) group and no SPS group. Log-Rank test was used to compare the effective rate and effective time of the two groups. Results: a total of 215 responsible blood vessels were detected in 103 patients. Among them, 196 branches were individually embolized, 8 branches were embolized by endings, 11 branches were embolized with gelatin sponge particles. 103 patients were followed up for 6 ~ 50 months after operation. The median follow-up time was 21 months. The immediate hemostasis rate was 97.1% (100 / 103). The effective rates of 1 month, 3 months, 6 months, 1 year, 2 years and 3 years of the patients were 94. 5%, 93. 2% and 89. 7%, respectively, and 88. 9% and 76. 6%, respectively, in which 22 patients were in the SPS group. No SPS group 81 cases. The 1-year effective rates of patients with SPS and without SPS were (69.5 鹵0.11)% and (98.3 鹵0.03)%, respectively, and the total effective rates were 55.6% and 82.7%, respectively. The median effective time was 25 (24.8 鹵3.37) months and 42 (42.2 鹵1.50) months, respectively. Conclusion: according to the type, quantity, structure, shape and communication of responsible blood vessel, the method of individualized multiple embolization can not only make hemoptysis timely, but also be controlled effectively. Moreover, the early, middle and long term recurrence rate caused by the establishment of collateral circulation and recanalization of responsible blood vessels was significantly reduced. However, the presence of SPS will affect the clinical efficacy of the embolization technique. Therefore, in the course of angiography, attention should be paid to look for SPS, and give it a case based on its structural characteristics, so as to achieve tamped embolization effect and improve the postoperative effect as far as possible.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R459.7
本文編號：2324080
[Abstract]:Objective: to discuss the key points of individualized multiple embolization in the treatment of intractable massive hemoptysis, to evaluate the clinical effect of the embolization method and to analyze the influence of the presence of body-pulmonary circulation shunt on the postoperative outcome. Methods: the data of 103 patients with intractable hemoptysis were analyzed retrospectively. The type, quantity, abnormal branches, pulmonary circulation and / or peripulmonary circulation shunt of the responsible vessels were determined by angiography, combined with disease types, to polyvinyl alcohol granules, Sodium alginate microspheres were used as the basic embolization agent for individualized multilevel embolization. According to the improvement of hemoptysis symptoms, the early (3 months), the middle (3 ~ 6 months) and the long term (6 months after operation) were evaluated. The Kaplan-Meier survival curve was used to evaluate the efficacy of individualized multiple embolization in the treatment of intractable massive hemoptysis. According to the characteristics of responsible blood supply, patients were divided into two groups: (SPS) group and no SPS group. Log-Rank test was used to compare the effective rate and effective time of the two groups. Results: a total of 215 responsible blood vessels were detected in 103 patients. Among them, 196 branches were individually embolized, 8 branches were embolized by endings, 11 branches were embolized with gelatin sponge particles. 103 patients were followed up for 6 ~ 50 months after operation. The median follow-up time was 21 months. The immediate hemostasis rate was 97.1% (100 / 103). The effective rates of 1 month, 3 months, 6 months, 1 year, 2 years and 3 years of the patients were 94. 5%, 93. 2% and 89. 7%, respectively, and 88. 9% and 76. 6%, respectively, in which 22 patients were in the SPS group. No SPS group 81 cases. The 1-year effective rates of patients with SPS and without SPS were (69.5 鹵0.11)% and (98.3 鹵0.03)%, respectively, and the total effective rates were 55.6% and 82.7%, respectively. The median effective time was 25 (24.8 鹵3.37) months and 42 (42.2 鹵1.50) months, respectively. Conclusion: according to the type, quantity, structure, shape and communication of responsible blood vessel, the method of individualized multiple embolization can not only make hemoptysis timely, but also be controlled effectively. Moreover, the early, middle and long term recurrence rate caused by the establishment of collateral circulation and recanalization of responsible blood vessels was significantly reduced. However, the presence of SPS will affect the clinical efficacy of the embolization technique. Therefore, in the course of angiography, attention should be paid to look for SPS, and give it a case based on its structural characteristics, so as to achieve tamped embolization effect and improve the postoperative effect as far as possible.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R459.7
【參考文獻】
相關(guān)期刊論文 前1條
1 張宏文;王小宜;廖偉華;鄧小軍;鄧梨平;段詩姣;肖燕;謝衛(wèi)華;;α-氰基苯烯酸正辛酯靶血管栓塞治療難治性大咯血[J];介入放射學雜志;2013年11期
，本文編號：2324080
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