Angiographic Appearance and Embolotherapeutic Management of Hemoptysis in Patients with Chronic Destructive Lung Diseases

慢性肺疾病患者血管檢查表徵及血管栓塞之評估

張潤忠(Yun-Chung Cheung) ； 呂嘉偉(Kar-Wai Lui) ； 黃浩輝(Ho-Fat Wong) ； 萬永亮(Yung-Liang Wan) ； 吳樹鏗(Shu-Hang Ng) ； 陳耀亮(Yao-Liang Chen)

《中華放射線醫學雜誌》 24卷1期 (1999/02) Pp. 21-26

摘要

利用血管栓塞術控制因慢性破壞性肺疾病引起咳血，探討其在血管檢查的表徵及評估其血管栓塞治療的效果。本文回顧15名因咳血而接受血管栓塞治療之病人，包括7名支氣管擴張症、3名肺結核、5名同時存在支氣管擴張症及肺結核。評估其在血管檢查表徵包括血管擴張、血管密度增高、微血管塗鴉、動靜脈交通、及出血表徵。12名病人接受高選擇性血管栓塞治療，3名病人無法達成高選擇性血管栓塞治療。本文係所選用之栓塞物皆是永久性的，包括polyvinyl alcohol particles（8病例），stainless steel coils（3病例），polyvinyl alcohol particles及Stainless steel coils（4病例）。14病例達成馬上止血的目的。血管表徵包括15例血管擴張，13例血管密度增高，10例微血管塗鴉，8例動靜脈交通，3例出血表徵。在治療成果方面，3例(20%)在兩星期內發生再咳血復發，需要再接受血管栓塞治療，並獲得控制。一病人因肺衰弱於術後死亡。長期追蹤發現11例持續有間斷性輕微咳血。總結本文係治療效果，獲得完全治療者計有3例(20%)，短暫控制者有3例(20%)，不完全治療者有11例(72.6%)，失敗者有1例(6.6%)。認識血管檢查表徵是血管栓塞治療咳血的根基。慢性破壞性肺疾病之病患常伴有肺功能衰弱，往往無法接受外科手術治療，在這情形下，血管栓塞控制咳血更顯重要。雖然微量咳血常持續，但對控制急性咳血的效果是肯定的，可減少因出血造成呼吸道阻塞死亡之發生，並可改善病患生活品質。

關鍵字

肺，出血 ； 胸腔，介入性步驟 ； 血管攝影，技術

並列摘要

To discuss the angiographic findings and efficacy of embolotherapy in controlling hemoptysis in the patients with chronic destructive lung diseases. Fifteen patients with acute hemoptysis treated with emergent transcatheter arterial embolization were included in this report. Underlying causes of hemoptysis were bronchiectasis in 7 cases, tuberculosis in 3 and both in 5. Angiographic findings were categorized as arterial hypertrophy, hypervascularity, fine vascular blushes, systemic- pulmonary shunts and extravasation. Superselective arterial embolization with a coaxial system with Tracker-18 microcatheters was successful in 12 of the 15 patients. In three patients in whom, superselective catheterization was not successful were embolized via a guiding catheter. Permanent embolizers of polyvinyl alcohol particles (8 cases), stainless steel coils (3 cases) and both (4 cases) were used in order to minimize recurrence due to arterial recanalization. In fourteen patients immediate control of hemoptysis occurred. Angiography showed hypertrophied arteries in 15 patients, hypervascularity in 13, fine vascular blushing in 10, systemic- pulmonary shunts in 8 and extravasation in 3. Three patients (20%) had recurrent hemoptysis within two weeks which was subsequently alleviated by repeat embolization. One patient had uncontrollable hemoptysis and died secondary to severe respiratory failure. Minor hemoptysis (11 cases) occurred frequently during long-term follow up. In summary, responses to embolotherapy were as follow: complete response (CR) in 3 cases (20%), partial immediate response (PIR) in 3 cases (20%), partial response (PR) in 11 cases (72.6%) and no response (NR) in 1 case (6.6%). Recognition of angiographic findings is the basis for therapeutic embolization. In patients with severe chronic lung disease who are not candidates for surgery, embolotherapy is effective and valuable in controlling acute hemoptysis. Although there was a high recurrence of minor hemoptysis, this procedure can greatly improve a patient's survival and life quality.

並列關鍵字

Lung, hemorrhage ； Thorax, interventional procedure ； Angiography, technology