| Objective: To investigate the clinical application value of bronchial artery CTA comprehensive post-treatment technique in emergency massive hemoptysis bronchial artery embolization.Methods: According to the standard set,collect cangzhou central hospital in August 2017 to August 2019 in the hospital line DSA bronchial artery embolization of large hemoptysis patients,106 cases of emergency,whether preoperative bronchial artery CTA examination,the patients were divided into group A and group B,the preoperative bronchial artery CTA DSA after bronchial artery embolization performer for group A,no bronchial artery CTA examination preoperatively,DSA bronchial artery embolization performer for group B directly.There were 78 cases in group A and 28 cases in group B.Research contents:1.Observe and reconstruct the three-dimensional model of hemoptysis responsibility vessel by CTA post-processing technology before operation,record and compare the origin,opening position,quantity and course of CTA and DSA.2.The mean operation time and dose of contrast agent during bronchial artery embolization in the two groups were compared,and the efficacy of embolization and follow-up for 6 months were paid close attention to after the operation,and the success rate of the first interventional embolization after the operation was compared between the two groups.3.To study the relationship between the opening characteristics of BA and the stability of angiography catheter MIK and CB2.4.All the data collected were analyzed by SPSS 23.0.Results:1.In group A,145 hemoptysis responsibility BAs were detected in CTA,of which 19 were of ectopic origin;in group A,there were 155 hemoptysis responsibility BAs in DSA,of which 20 were of ectopic origin.With DSA as the gold standard,the sensitivity and specificity of CTA to detect BA in hemoptysis were 93.55%(145 / 155)and 100%(145 / 145),respectively.The sensitivity and specificity of CTA to detect BA of ectopic origin were 95.00%(19 / 20)and 100%(19 / 19),respectively.CTA is less effective in detecting B-P shunt or systemic pulmonary shunt than DSA.2.The average operation time in group A was significantly shorter than that in group B(P = 0.000 < 0.05),and the dosage of contrast agent in group A was significantly lower than that in group B(P = 0.000 < 0.05).3 cases in group A and 5 cases in group B had massive hemoptysis within 24 hours after operation,and the secondary embolization was successful.There were no serious complications such as spinal cord injury and cerebral embolism in the two groups.The success rate of the first embolization was 96.15% in group A and 82.14% in group B.The success rate of the first embolization in group A was higher than that in group B(χ2 = 3.963,P = 0.047 < 0.05).3.The intubation stability of angiography catheter CB2 was significantly higher than that of MIK in group I(BA longitudinal opening range of 0°～ 59°and transverse opening range of 0°～ 44°),there are significant difference(P = 0.008 < 0.05);and that in group II(longitudinal opening 60°～ 119°and transverse opening range of 0°～ 44°)was significantly higher than that of MIK(P = 0.039 < 0.05);and that in group III(longitudinal opening range of 120°～ 180°and transverse opening range of 0°～ 44°),group IV(longitudinal opening range of 0°～ 59°and transverse opening 45°～ 90°)and group V(longitudinal opening 60°～ 119°and the transverse opening 45°～ 90°),there was no significant difference in the intubation stability between angiography catheter MIK and CB2(P > 0.05);In Group VI(longitudinal opening range of 120°～ 180°and transverse opening 45°～ 90°),the intubation stability of angiography catheter MIK has a higher potential trend than CB2,but there was no significant difference(P = 0.061 > 0.05).Conclusions:1.The comprehensive post-treatment of bronchial artery CTA can timely detect and evaluate the origin,opening,quantity and imaging characteristics of the bronchial artery responsible for hemorrhage.2.Under the guidance of bronchial artery CTA,the surgeon can quickly and accurately find the responsibility of bleeding BA,significantly shorten the time of interventional surgery,reduce the amount of contrast agent,and improve the success rate of the first interventional embolization,which has important clinical application value for the timely and accurate treatment of emergency hemoptysis.3.Responsibility for normal origin BA: when the longitudinal opening ranges from 0°to 59°and the transverse opening ranges from 0°to 44°,the intubation stability of choosing the angiography catheter CB2 is significantly better than that of MIK;when the longitudinal opening ranges from 60°to 119°and the transverse opening ranges from 0°to 44°,the intubation stability of the choosing angiography catheter CB2 is better than that of MIK.When the longitudinal opening ranged from 0°to 120° and the transverse opening ranged from 45°to 90°,there was no significant difference in the intubation stability of angiography catheter CB2 and MIK.When the longitudinal opening ranged from 120°to 180°and the transverse opening ranged from 45°to 90°,the intubation stability of angiography catheter MIK had a higher potential trend than that of CB2,but there was no significant difference. |
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