The Study Of Intervention Therapy Of Refractoriness Hemoptysis Complicating With Bronchial Artery To Pulmonary Circulation Shunt (Basic And Clinical Application)

Objective:Bronchial artery to pulmonary circulation shunt (BPS) is one pathologic reason of refractoriness hemoptysis.There are about 30%-60% hemoptysis due to BPS. Those who accepted traditionary bronchial arterial embolism (BAE) treatment usully have highly recurrence rate. BPS with small quantity hemoptysis those who can treat with internal expectant treatment. Surgery usely have postivly therapeutic effect,but it must patient condition permissive and focus of infection limited. The experience come from treat inborn BPS by BAE. There are many difference between inborn BPS and non-inborn BPS, such as:etiopathgenisis,symptom,treatment,pathology type. The interventional therapy of non-inborn BPS have a few reports.there is no deeply and system research. At the same time, because of limit of BEA treatment, safety can not be ignore when we focus on its therapeutic effect. Therefore,to research and improve treatment method very important. Our research is to find out general methods to treatde of refractoriness hemoptysis due to BPS. Method:This research is include two part:animal experiment and clinical research. Frist part is to study 20 rabbits those is treated by pulmonary embolism by diameter 50μm 100μm,150μm,200μm,250μm self-made Fe3O4 fine particle and 500μm-1000μm diameter self-made gelatin sponge fine particle. Those gelatin sponge have two type:No 1 is high pressure barffing; No 2 did not barffing. When 1,2,4 week after embolistion, we recheck rabbit by DSA and execute. Take samples observe by HE dyeing. Part two is clinical application. Which was to collected 212 cases of refractoriness hemoptysis treated by BAE during 1996.9-2010.2. Among those who have be confirmed by DSA angiography.The number is 99 cases. Male 72 and female 27,years of age 11-75,average 47.6. There are 25 of bronchiectasis. 64 tuberculosis,10 inflammation. The gelatin sponge group is use gelatin sponge mix with non-ion contrast transcatheter embolization,then push 2mm×10mm gelatin sponge sliver until the bronchial artries trunk blunting and BPS disappear.Permanent embolism group,accord to angiography,use 100-250μm Fe3O4 fine particle or 300-700μm polyvinyl alcohol (PVA) particle suff to emblism BPS,then use 3mm-5mm Coil or gelatin sponge sliver to emblism bronchial artries trunk, until the bronchial artries trunk blunting and BPS disappear. All case be follow-up visit after one day, two week, four week,six month,one year,two years.Result:Part one:angiography and pathology demonsteated 50μm 150μm,250μm Fe3O4 fine particle and gelatin sponge could embolized differcent level microcirculation blood vessel.50μm Fe3O4 fine particle can embolized 120±70μm in diameter micrangium and precapillary arteriole,whileas, 100μm embolized 230±89μm,150μm embolized 257±98μm,200μm embolized 359±109μm,250μm embolized 550±135μm. All have nice embolism effective.50μm-250μm can pass though microtubule. gelatin sponge can not pass though microtubule. Part two:37 out 47 cases of patients with gelatin sponge embolization were completed cessation of hemoptysis during long time,and non-relapsed technical successful rate was 79%.Followed-up 1-2 years,20 patients relapsed in there month,the overall effective rate was 70.83%.The embolization with Gelfoam only is in the most possibility of recurrent.There is no distinctive disparity between Gelfoam group and other group.Diseased region with multi blood supply is 13.3 times to recurrence than solo bloodsupply after embolization.The therapy with only Gelfoam is most likely to relapse and hasshorter time to recur.Conclusion The embolization with PVA or Gelfoam and PVA is aeffective procedure for hemoptysis.The embolic agent with only Gelfoam and the patients with multi blood supply to dieased region dose not have a satisfactory outcome.Conclusion:Animal experiment indicted:1,Fe3O4 fine particle safety and material easily earn,It used facility and can pass though 3 f microtubule and can do ultraselection embolized.2,,Fe3O4 fine particle has satisfactory Embolization effect,which has duration,completely,thoroughly embolization-. un-capablity recanalization and is a good kind of permanent embolization agent.3 Gelfoam as embolization agent it can capablity recanalization,bypass circuit easy to establish,it can use as assist agent in permanent embolization.4,Steel coil could used to embolism the main bronchial artery which could decrease the blood flow in those eara permanently. Clinical application indicted:bronchial arterial permanent embolism is a effect method to cure refractoriness Hemoptysis and better than Gelfoam.2, those case have Bronchial artery to pulmonary artery shunt use fine particle to embolized have satisfactory embolization effect and usely have little complication. It can use as frist chose method, Around lung systemic circulation to pulmonary circulation shunt(ALSPS)have same effect.3 Bronchial artery to pulmonary vein shunt and Around lung systemic circulation to vein shuntshould be carefully used biger fine particle during embolizing such as biger then 500μm in diameter.4, in complex PBS: Our strategy is to embolize all feeding artery and obey the same principle as BVS and ALSVS.