胸廓内动脉栓塞在肺咯血动脉栓塞治疗中的应用  

Application of Internal Mammary Arterial Embolization in Artery Embolism for Hemoptysis

作　　者：江森[1] 朱晓华[1] 孙兮文[1] 支文祥[1] 虞栋[1] 彭刚[1] 尤正千[1] 马骏[1] 

机构地区：[1]上海同济大学附属肺科医院影像科,200433

出　　处：《临床放射学杂志》2007年第5期492-495,共4页Journal of Clinical Radiology

摘　　要：目的探讨胸廓内动脉(IMA)栓塞在肺咯血动脉栓塞治疗中的临床应用。资料与方法13例肺咯血患者,在完成降主动脉各分支出血动脉栓塞术后,根据对患者术前的影像学资料及术中的DSA图像进行综合分析后行单侧或双侧锁骨下动脉造影,对出血的IMA行栓塞术。术后进行疗效评定和并发症分析。结果出血的IMA有不同程度扭曲、增粗、增生、动脉瘤样改变、动脉与肺循环分流、对比剂外渗等,基础病变多为慢性纤维空洞型肺结核。栓塞术后即时止血率为100%,符合长期随访的10例患者中治愈5例(50%),显效和好转4例(40%),无效1例(10%)。术后并发症有中低度发热,恶心、呕吐,胸痛,呃逆,呼吸困难并发呼吸衰竭。结论肺咯血的支气管动脉栓塞术治疗应结合基础病变性质、部位并仔细分析术前、术中各影像学资料后行相应的锁骨下动脉造影以检出出血的IMA,对其进行栓塞以完善治疗效果,并且IMA栓塞术是安全的。Objective To discuss the clinical application of internal mammary arterial （IMA） embolization in artery embolism for hemoptysis. Materials and Methods 13 cases of hemoptysis undertook IMA embolization after embolizing with branches of decending aorta on the basis of patient＇s preoperative imageology and intraoperative DSA imaging data. All cases were analyzed for clinical efficacy and complications. Results Hemorrhagic IMA appeared tortuosity, dilatation, hyperplasia, aneurysm, shunt with pulmonary circulation and extravasation of contrast media, et al. Many patients had chronic fibro-cavernous pulmonary tuberculosis. The postoperative immediate cessation rate of hemoptysis reached 100% . 10 cases with long-term follow-up were cured in 5 （50%）, excellence and improve in 4 （40%）, inefficacy in 1 （ 10% ）. The complications occurred with fever, vomiting, chest pain, hiccup and dyspnoea. Conclusion It is necessary that familiarize patient＇ s primarily diseases, preoperative and intraoperative imaging data when undertaking bronchial artery embolization for hemoptysis and perform corresponding subclavian artery angiography to search the hemorrhagic IMA. IMA embolization is safety and improve therapeutic efficacy in artery embolism for hemoptysis.

关 键 词：咯血 胸廓内动脉 支气管动脉 栓塞 肺结核 

分 类 号：R56[医药卫生—呼吸系统]