目的 分析肺结核支气管动脉栓塞术 (BAE) 术后再发咯血患者采用主动脉弓造影联合排查造影法寻找咯血责任血管的临床价值.方法 48例行介入手术的肺结核BAE术后再发咯血患者, 按照手术方法的不同分为A组 (14例) 和B组 (34例) .A组采取单独排查造影法, B组采取主动脉弓造影联合排查造影法.观察比较两组再发咯血责任血管发现情况、介入手术后短期复发率及短期再次大咯血所致二次手术率.结果 A组发现咯血责任血管共41条, 平均 (2.78±1.19) 条;B组发现咯血责任血管共137条, 平均 (4.09±1.31) 条, B组发现咯血责任血管明显多于A组, 差异有统计学意义 (P=0.002＜0.05) .A组介入手术后短期复发4例, 短期再次大咯血所致二次手术3例;B组介入手术后短期复发1例, 短期再次大咯血所致二次手术0例.B组介入手术后短期复发率、短期再次大咯血所致二次手术率分别为2.94％、0, 均明显低于A组的28.57％、21.43％, 差异均有统计学意义 (P=0.008、0.005＜0.05) .结论 主动脉弓造影联合排查造影法在寻找再发咯血责任血管中有着重要的临床意义, 能够增加再发咯血责任血管的发现, 降低介入手术后短期复发率及短期再次大咯血所致二次手术率.%Objective To analyze the clinical value of aortic arch angiography combined with angiography in finding responsible blood vessels for recurrent hemoptysis in pulmonary tuberculosis after bronchial artery embolization (BAE). Methods A total of 48 patients with recurrent hemoptysis after BAE for pulmonary tuberculosis undergoing interventional surgery were divided by different surgical methods into group A (14 cases) and group B (34 cases). Group A received angiography only, and group B received aortic arch angiography combined with angiography. Observation and comparison were made on detection of responsible vessels for recurrent hemoptysis, short-term recurrence rate after interventional surgery and secondary operation rate caused by short-term massive hemoptysis between the two groups. Results Group A had 41 blood vessels responsible for hemoptysis, with an average of (2.78±1.19) pieces, and group B had 137 blood vessels responsible for hemoptysis, with an average of (4.09±1.31) pieces. Group B had obviously more blood vessels responsible for hemoptysis than group A, and the difference was statistically significant (P=0.002＜0.05). Group A had 4 shortterm recurrence cases after interventional surgery, 3 secondary operation cases caused by short-term massive hemoptysis, while group B had 1 short-term recurrence case after interventional surgery, and 0 secondary operation case caused by short-term massive hemoptysis. Group B had obviously lower short-term recurrence rate after interventional surgery and secondary operation rate caused by short-term massive hemoptysis respectively as 2.94％ and 0 than 28.57％ and 21.43％ in group A, and their difference was statistically significant (P=0.008, 0.005＜0.05). Conclusion Combination of aortic arch angiography and angiography in finding responsible blood vessels for recurrent hemoptysis can increase the discovery of responsible blood vessels for recurrent hemoptysis, reduce the short-term recurrence rate after interventional surgery and the secondary operation rate caused by short-term massive hemoptysis.
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