目的 分析非肿瘤大咯血患者行支气管动脉栓塞治疗后复发咯血的原因,并探讨其预防措施.方法 随访观察152例非肿瘤性咯血患者,其中62例行栓塞治疗后1年内再次咯血.再行支气管动脉造影许行栓塞治疗,复习其首次造影经过,并分析柃塞颗粒选择与咯血复发的关系.结果 栓塞治疗后1 周内咯血复发12例,1周～1个月内咯血复发9例,1～6个月内咯血复发15例,1年内咯血共复发62例.再次造影并与首次咯血时造影片比较显示,原栓塞支气管动脉冉通敏咯血复发25例(均为采用单纯明胶海绵颗粒栓塞);病变由多支支气管动脉供血,但首次血管内介入治疗时遗漏供血支气管动脉支致咯血复发16例;首次血管内介入治疗时遗漏肺外体循环供血动脉支致咯血复发9例;病变内新的侧支供血动脉支建立并开通致咯血复发12例(明胶海绵颗粒并微弹簧圈栓塞).结论 全面观察了解并彻底柃塞咯血供血动脉支,以不可吸收性栓塞微粒完全填闭病变血管床可避免咯血复发.%Objective To analyze the causes of non-tumorous recurrent hemoptysis after transcatheter embolization of bronchial artery and to discuss its prevention measures. Methods Transcatheter embolization of bronchial artery was carried out in 152 patients with acute non-tumorous hemoptysis, of whom recurrent hemoptysis within one year occurred in 62. and super-selective angiography of bronchial artery and other systemic arteries were performed again, based on which embolization therapy was repeated. The initial angiography was reviewed. The relationship between the embolization material and the recurrence of nontumorous hemoptysis was analyzed. Results Hemoptysis recurrence occurred in one week. one, 6 and 12 months after embolization was seen in 12, 21. 36 and 62 cases, respectively. Recurrent hemoptysis in 25 patients was caused by the recanalization of Gelfoam-emholized bronchial artery. The recurrent hemoptysis in 16 patients was due to the missing embolization of diseased bronchial artery branch and in another 9 patients was due to the missing embolization of diseasecl systemic artery which fed the hemoptysis lesions. The newlyestablished collateral circulation inside the hemoptysis lesions accounted f'or the recurrent hemoptysis in 12 patients who had received embolization with Gelfoam particles and micro-spring coils. Conclusion To find out all feeding arteries of hemoptysis lesion. to use un-absorbable embolization particles and to occlude all the feeding arteries completely are the key points for avoiding the recurrent hemoptysis. (J Intervent Radiol.2011. 20: 18-21)
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