咯血患者的食管固有动脉造影表现和栓塞治疗  

Angiographic manifestation and transcatheter arterial embolization of proper esophageal artery in hemoptysis

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

机构地区：[1]同济大学附属上海市肺科医院放射科,200433

出　　处：《中华放射学杂志》2008年第6期641-644,共4页Chinese Journal of Radiology

摘　　要：目的观察咯血患者的食管固有动脉（PEA）血管造影表现，分析出现异常PEA的高危因素，评价明胶海绵（GS）栓塞PEA的安全性。方法对接受动脉栓塞治疗的43例咯血患者行选择性PEA造影术，包括肺结核15例，单纯性支气管扩张18例，结核性支气管扩张7例，支气管肺癌3例。1例1次支气管动脉栓塞术后无效。对发现异常的PEA行GS经导管内栓塞。观察选择性PEA插管的结果，分析PEA的血管造影表现。经导管补充栓塞PEA的所有患者，随访观察术中、术后的不良反应、并发症以及临床治疗效果。结果PEA选择性插管成功37例（86．0％），共发现39支PEA，PEA表现异常17例（45．9％），血管18支（46、2％），主要表现为主干增粗、迂曲，分支增多、紊乱并进入相邻下肺组织，PEA与肺动脉分流11例，4例PEA发出1支下肺支气管动脉并与正常起源的支气管动脉异常交通2例。PEA表现异常患者中，病灶均累及肺下叶基底段，其中基础疾病以单纯性支气管扩张最多。所有患者栓塞术后均无严重并发症，临床疗效满意。结论PEA可参与咯血的供血，当肺内病灶累及下叶基底段时，有必要行选择性PEA造影。异常的PEA应用GS经导管补充栓塞是必要和安全的。Objective To investigate the angiographic manifestation of the proper esophageal artery （ PEA）, the high risk faetors for the presenee of the anomalous PEA in hemoptysis and to evaluate the safety of transeatheter arterial embolization （TAE） of the PEA using gelatin sponge （GS）. Methods Seleetive esophageal arteriography was performed in forty-three patients with hemoptysis, ineluding 15 eases of pulmonary tubereulosis, 18 eases of bronehieetasis, 7 eases of posttubereulous bronehieetasis and three eases of lung eaneer. One ease experieneed failure of bronehial arterial embolization. The angiographie manifestation of the PEAs was studied. The eomplieations of the proeedure and elinieal results were observed in the patients who underwent TAE using GS. Results Thirty-nine PEAs were eatheterized seleetively in 37 patients （86.0%）. Eighteen anomalous PEAs （46.2%） were eatheterized seleetively in 17 patients （45.9%）. The anomalous PEAs showed tortuosity, dilatation, hyperplasia, shunting with pulmonary artery and anastomosis with the bronehial artery. All lesions involved basal segment of inferior pulmonary lobar. Bronehieetasis was the most frequent disease for PEA abnormality. No eomplieations oeeurred and satisfaetory eurative effeet was aehieved with TAE of the anomalous PEAs. Conclusions It is neeessary to perform seleetive proper esophageal arteriography when the lesion involves basal segment of inferior pulmonary lobar in hemoptysis. Supplemental TAE of the anomalous PEA using GS is safe and valuable in the management of hemoptysis.

关 键 词：动脉 食管 咯血 放射学 介入性 栓塞 治疗性 

分 类 号：R686[医药卫生—骨科学]