支气管动脉栓塞联合肺叶切除治疗咯血分析
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摘要
目的比较咯血患者支气管动脉栓塞联合肺叶切除的治疗模式与常规肺叶切除术的手术安全性和术后并发症。方法回顾我院2013年～2018年85例因咯血内科治疗无效,肺部器质性改变明显,需行肺叶切除术的病例资料。37例行支气管动脉栓塞术,再择期全麻下胸腔镜加小切口行肺叶切除术;另48例患者仅于全麻下胸腔镜加小切口行肺叶切除术。比较支气管动脉栓塞术加肺叶切除术联合治疗和单纯性肺叶切除术,统计手术操作时间、术中出血、术后3 d胸腔引流管渗液量和术后出院时间的差别。结果本组数据显示,在单一肺叶切除术中,术前行支气管动脉栓塞术的联合治疗组手术时间和术后3 d胸腔渗液分别为(5.14±1.21) h和(855.00±481.18) ml,未行支气管动脉栓塞术的单一肺叶切除组分别为(6.24±1.94) h和(1172.65±558.63) ml,差异有统计学意义(P<0.05),而术中出血和术后住院天数,两组无统计学差异(P>0.05);在复合肺叶切除术中,联合治疗组手术时间、术中出血、术后3 d胸腔渗液和术后住院天数分别为(6.00±1.25) h、(459.33±318.26) ml、(970.67±293.61) ml和(14.87±4.96) d,对照组分别为(7.29±1.73) h、(862.14±630.22) ml、(1332.86±212.22) ml和(22.14±11.65) d,差异均有统计学意义。结论咯血患者肺叶切除前行支气管动脉栓塞术,在手术安全性和并发症控制上优于常规肺叶切除术,在复杂肺叶切除术中的作用更加明显。
Objective To compare treatment of hemoptysis by combined bronchial artery embolization and lobectomy with conventional lobectomy alone. Methods 85 patients with lung parenchymal changes and ineffective medical treatment of hemoptysis from 2013 to 2018 underwent lobectomy(48) or bronchial artery embolization followed by lobectomy(37). The operation time, intraoperative bleeding, post-operative pleural effusion, and postoperative hospital stay were compared between the two groups. Results In simple lobectomy, the operation time (5. 14 ± 1. 21 h) and volume of post-operative pleural effusion within 3 days (855. 00 ±481.18 ml) in the combined treatment group were significantly lower than that of lobectomy alone(6.24±1.94 h, 1172.65±558.63 ml).There was no statistical difference in intra-operative bleeding and post-operative hospital stay. In compound lobectomy, the operation time(6.00 ±1.25 h), intraoperative bleeding(459.33 +318.26 ml), pleural effusion(970.67 ±293.61 ml) and hospital stay(14.87±4.96 d) for the combined treatment group were significantly lower than that of lobectomy alone(7.29±1.73 h, 862.14±630.22 ml,1332.86 ±212.22 ml, 22.14 ±11.65 d). Conclusion Bronchial artery embolization before lobectomy is superior to conventional lobectomy in surgical safety and complication control of hemoptysis.
Objective To compare treatment of hemoptysis by combined bronchial artery embolization and lobectomy with conventional lobectomy alone. Methods 85 patients with lung parenchymal changes and ineffective medical treatment of hemoptysis from 2013 to 2018 underwent lobectomy(48) or bronchial artery embolization followed by lobectomy(37). The operation time, intraoperative bleeding, post-operative pleural effusion, and postoperative hospital stay were compared between the two groups. Results In simple lobectomy, the operation time (5. 14 ± 1. 21 h) and volume of post-operative pleural effusion within 3 days (855. 00 ±481.18 ml) in the combined treatment group were significantly lower than that of lobectomy alone(6.24±1.94 h, 1172.65±558.63 ml).There was no statistical difference in intra-operative bleeding and post-operative hospital stay. In compound lobectomy, the operation time(6.00 ±1.25 h), intraoperative bleeding(459.33 +318.26 ml), pleural effusion(970.67 ±293.61 ml) and hospital stay(14.87±4.96 d) for the combined treatment group were significantly lower than that of lobectomy alone(7.29±1.73 h, 862.14±630.22 ml,1332.86 ±212.22 ml, 22.14 ±11.65 d). Conclusion Bronchial artery embolization before lobectomy is superior to conventional lobectomy in surgical safety and complication control of hemoptysis.
引文
[1]李深洋,陈立新,郑柏泉.支气管动脉栓塞治疗大咯血的临床应用.影像诊断与介入放射学,2011,20:61-63.
[2]Thompson AB,Teschler H,Rennard SI.Pathogensis,evaluation,and therapy for massive hemoptysis.Clin Chest Med,1992,13:69-82.
[3]张莉,于世平,苏秀琴,等.逐级多重栓塞治疗顽固性大咯血的技术探讨和疗效观察.中华放射学杂志,2015,49:605-609.
[4]徐伟,史中兴,徐春阳,等.支气管扩张大咯血的急诊介入栓塞治疗.医学影像学杂志,2014,24:1903-1906.
[5]Ramírez Mejía AR,Méndez Montero JV,Vásquez-Caicedo ML,et al.Radiological evalution and endovascular treatment of hemoptysis.Curr Probl Diagn Radiol,2016,45:215-224.
[6]许俊,倪正义,周密.86例大咯血急诊肺切除术临床分析.临床肺科杂志,2011,16:378-379.
[7]Otani Y,Yoshida I,Ohki S,et al.Arterial embolization as preoperative treatment for pulmonary aspergillosis with hemoptysis.Surg Today,1997,27:812-815.
[8]Alexander GR.A retrospective review comparing the treatment outcomes of emergency lung resection for massive haemoptysis with and without preoperative bronchial artery embolization.Eur J Cardiothorac Sury,2014,45:251-255.
[9]陆文彬,刘霆,孙松,等.支气管动脉栓塞治疗大咯血的临床应用.影像诊断与介入放射学,2011,20:128-129.
[10]胡汶斌,袁顺达,俞幼林,等.胸腔镜辅助小切口与传统开胸手术治疗结核性毁损肺效果比较.中华结核和呼吸杂志,2016,39:143-144.
[11]徐旭东,叶波,陈达,等.经导管动脉栓塞在结核性毁损肺胸膜全肺切除术前中的应用.中华急诊医学杂志,2014,23:565-567.
[12]江森,朱晓华,孙兮文,等.非支气管性体动脉引起咯血的发病情况及介入栓塞疗效分析.中华放射学杂志,2009,43:629-633.
[13]Chen G,Zhong FM,Xu XD,et al.Efficacy of regional arterial embolization before pleuropulmonary resection in 32 patients with tuberculosis-destroyed lung.BMC Pulm Med,2018,18:156.
[14]朱建坤,刘大伟,金锋,等.顽固性咯血患者肺叶切除术前行动脉栓塞介入治疗的价值.中国防痨杂志,2018,40:1258-1261.
[15]El Hammoumi MM,Slaoui O,El Oueriachi F,et al.Lung resection in pulmonary aspergilloma:experience of a Moroccan Center.BMC Surg,2015,15:114.
[2]Thompson AB,Teschler H,Rennard SI.Pathogensis,evaluation,and therapy for massive hemoptysis.Clin Chest Med,1992,13:69-82.
[3]张莉,于世平,苏秀琴,等.逐级多重栓塞治疗顽固性大咯血的技术探讨和疗效观察.中华放射学杂志,2015,49:605-609.
[4]徐伟,史中兴,徐春阳,等.支气管扩张大咯血的急诊介入栓塞治疗.医学影像学杂志,2014,24:1903-1906.
[5]Ramírez Mejía AR,Méndez Montero JV,Vásquez-Caicedo ML,et al.Radiological evalution and endovascular treatment of hemoptysis.Curr Probl Diagn Radiol,2016,45:215-224.
[6]许俊,倪正义,周密.86例大咯血急诊肺切除术临床分析.临床肺科杂志,2011,16:378-379.
[7]Otani Y,Yoshida I,Ohki S,et al.Arterial embolization as preoperative treatment for pulmonary aspergillosis with hemoptysis.Surg Today,1997,27:812-815.
[8]Alexander GR.A retrospective review comparing the treatment outcomes of emergency lung resection for massive haemoptysis with and without preoperative bronchial artery embolization.Eur J Cardiothorac Sury,2014,45:251-255.
[9]陆文彬,刘霆,孙松,等.支气管动脉栓塞治疗大咯血的临床应用.影像诊断与介入放射学,2011,20:128-129.
[10]胡汶斌,袁顺达,俞幼林,等.胸腔镜辅助小切口与传统开胸手术治疗结核性毁损肺效果比较.中华结核和呼吸杂志,2016,39:143-144.
[11]徐旭东,叶波,陈达,等.经导管动脉栓塞在结核性毁损肺胸膜全肺切除术前中的应用.中华急诊医学杂志,2014,23:565-567.
[12]江森,朱晓华,孙兮文,等.非支气管性体动脉引起咯血的发病情况及介入栓塞疗效分析.中华放射学杂志,2009,43:629-633.
[13]Chen G,Zhong FM,Xu XD,et al.Efficacy of regional arterial embolization before pleuropulmonary resection in 32 patients with tuberculosis-destroyed lung.BMC Pulm Med,2018,18:156.
[14]朱建坤,刘大伟,金锋,等.顽固性咯血患者肺叶切除术前行动脉栓塞介入治疗的价值.中国防痨杂志,2018,40:1258-1261.
[15]El Hammoumi MM,Slaoui O,El Oueriachi F,et al.Lung resection in pulmonary aspergilloma:experience of a Moroccan Center.BMC Surg,2015,15:114.