Utility of fiberoptic bronchoscopy before bronchial artery embolization for massive hemoptysis
Utility of fiberoptic bronchoscopy before bronchial artery embolization for massive hemoptysis
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DOI：
10.2214/ajr.177.4.1770861
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发表时间：
2001-10-01
影响因子：
5
通讯作者：
Baxter, RB
中科院分区：
文献类型：
--
作者：
Hsiao, EI;Kirsch, CM;Baxter, RB
目标。我们想要研究在大咯血患者行支气管动脉栓塞术前进行纤维支气管镜检查的实用性。我们回顾了1988至2000年间在两家地方医院、一家县医院和一家社区医院就诊的所有咯血患者，这些患者在行支气管动脉造影术前接受了纤维支气管镜检查。结果：29名符合纳入标准的患者被确定为符合纳入标准的患者；1名患者因缺少X线片而被排除。其余28例患者包括19名男性和9名女性，平均年龄54.6岁(年龄16-91岁)。临床诊断为结核性支扩(n=14，50.0%)，肺癌(n=4，14.3%)，活动性肺结核(n=2，7.1%)，非结核性支扩(n=2，7.1%)，活动性球虫病、胰瘘、动静脉畸形、法洛四联症(n=1，3.6%)，原因不明(n=2，7.1%)。23例(82.1%)支气管镜确定的出血部位与X线确定的出血部位一致，均为单侧病变(n=15)、双侧病变合并单侧空洞(n=5)、一侧占优势(n=3)。支气管镜检查是确定出血部位的必要工具，只有3名患者(10.7%)，所有患者都有支气管扩张症，在胸片上看不到明显的定位特征。在其余2例(7.1%)患者中，支气管镜检查结果不确定，但X线片是有帮助的。结论：对于原因不明的咯血患者，如果能通过X线片确定出血部位，且不需要支气管镜下的呼吸道管理，则在行支气管动脉栓塞术前不需要纤维支气管镜检查。
OBJECTIVE. We wanted to investigate the utility of performing fiberoptic bronchoscopy before bronchial artery embolization in patients with massive hemoptysis.MATERIALS AND METHODS. We retrospectively reviewed the cases of all patients with hemoptysis who had presented at either of two local hospitals, one county hospital and one community hospital between 1988 and 2000 and who had undergone fiberoptic bronchoscopy before bronchial arteriography. All data were abstracted using a standardized coding form, and radiographs were independently reviewed by two of the authors.RESULTS. Twenty-nine patients meeting the inclusion criteria were identified; one patient was excluded because of missing radiographs. The remaining 28 patients consisted of 19 men and nine women, with an average age of 54.6 years (age range, 16-91 years). The clinically determined diagnoses of their symptoms were tuberculous bronchiectasis (n = 14; 50.0%); bronchogenic carcinoma (n = 4; 14.3%); active tuberculosis (n = 2; 7.1%); nontuberculous bronchiectasis (n = 2; 7.1%) active coccidioidomycosis, pancreaticobronchial fistula, arteriovenous malformation, and tetralogy of fallot (n = 1 each; 3.6% each); and unknown cause (n = 2; 7.1 %). The bleeding site determined through bronchoscopy was consistent with that determined through radiographs in 23 patients (82.1%); all had either unilateral disease (n = 15), bilateral disease with unilateral cavities (n = 5), or a preponderance of disease on one side (n = 3). Bronchoscopy was an essential tool in determining the bleeding site in only three patients (10.7%), all of whom had bronchiectasis without localizing features visible on chest radiographs. In the remaining two patients (7.1%), bronchoscopic findings were indeterminate, but radiographs were helpful.CONCLUSION. Fiberoptic bronchoscopy before bronchial artery embolization is unnecessary in patients with hemoptysis of known causation if the site of bleeding can be determined from radiographs and no bronchoscopic airways management is needed.