非支气管性体动脉引起咯血的发病情况及介入栓塞疗效分析  

Nonbronchial systemic arteries： incidence and endovascular interventional management for hemoptysis

作　　者：江森[1] 朱晓华[1] 孙兮文[1] 尤正千[1] 马骏[1] 虞栋[1] 彭刚[1] 揭冰[1] 孙春轶[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》2009年第6期629-633,共5页Chinese Journal of Radiology

摘　　要：目的观察非支气管性体动脉（NBSA）引起咯血的发生率、与原发疾病的关系及行经导管动脉栓塞术（TAE）栓塞责任NBSA治疗咯血的效果。方法对139例接受TAE治疗的咯血患者行系统的主动脉和锁骨下动脉造影。患者原发病为：肺结核66例（2例有胸廓改良术史、1例有肺叶切除术史、1例合并室间隔缺损），单纯性支气管扩张41例（其中1例有肺叶切除术史、1例有动脉导管未闭结扎术史），支气管肺癌15例，隐原性咯血7例，尘肺3例，支气管结石3例，支气管囊肿1例，脓胸1例，肺癌术后1例，慢性肺栓塞1例。对发现的责任NBSA行栓塞术，观察NBSA引起咯血的发生概率、责任NBSA分布情况及与原发病的关系。随访观察临床疗效和并发症。随访时间6个月至5年。结果139例中73例（52．5％）咯血与出现病理性NBSA有关。共计181支责任NBSA，包括肋间后动脉88支、胸廓内动脉27支、膈下动脉21支、食管固有动脉20支、胸外侧动脉9支、肩胛下动脉7支、肋颈干5支、甲状颈干4支。肺结核患者咯血的责任NSBA以肋间后动脉（75支）和锁骨下、腋动脉的分支（4J4支）为主，单纯性支气管扩张者以食管固有动脉（16支）和膈下动脉（17支）为主。本组患者TAE后，即刻止血69例，包括1次以上支气管动脉栓塞术后支气管动脉（BA）已闭塞无效和复发的19例、BA正常的初治者4例。本组中除1例行锁骨下动脉造影术后出现同侧小脑梗死和1例行BA和胸廓内动脉栓塞术后发生呼吸衰竭外无其他严重并发症。获6个月以上的随访60例。术后间断性痰中带血16例；11例复发，10例再次TAE后停止咯血8例、间断性痰中带血2例，1例外科肺叶切除后咯血停止；其余未再咯血，但1例术后8个月死于肿瘤进展，1例术后2周死于原呼吸衰竭加重。结论相邻病灶的刺激和肺血流灌注不良或缺失的心血管疾病可致相�Objective To investigate the incidence and relation to primary diseases of the nonbronchial systemic arteries （NBSA） supply to the pulmonary lesions, and to evaluate the clinical value of transcatheter arterial embolization （TAE） of the responsible NBSA for hemoptysis. Methods The aortography and subclavian artery angiography were performed in 139 patients with hemoptysis, including pulmonary tuberculosis in 66 cases （2 cases with post-thoraeoplasty, 1 case with post-lobectomy, and 1 case with ventricular septal defect ）, bronchieetasis in 41 （ 1 case with post-lobectomy and 1 case with post- ligation of patent ductus arteriosus） , bronehiogenic carcinoma in 15, unknown hemoptysis in 7, silicosis in 3, broncholithiasis in 3, bronchial cysts in 1, empyema in 1, postoperative lung cancer in 1, and chronic pulmonary embolism in 1, respectively. TAE was performed in patients with the discoverable responsible NBSA. The frequency, distribution and relation to primary diseases of the responsible NBSA were evaluated and the clinical results and complications were observed. Follow-up time ranged from 6 months to 5 years. Results Seventy-three patients （52. 5% ） had nonbronchial systemic contributions, including 5 cases of post-thoracotomy with pulmonary lesions, 1 case complicating with ventricular septal defect, 1 case with post-ligation of patent ductus arteriosus, and 1 case of chronic pulmonary embolism. The total number of NBSA were 181 including posterior intercostal arteries （n = 88） , internal thoracic arteries （n = 27） , inferior phrenic arteries （ n = 21 ）, proper esophageal arteries （ n = 20 ） , lateral thoracic arteries （ n = 9 ）, subscapular arteries （ n = 7 ） , costocervical trunks （ n = 5 ） and thyrocervical trunks （ n = 4 ） . Main responsible NBSA were posterior intercostal arteries （n =75 ） and branches of subclavian and axillary artery （n= 44） in patients with pulmonary tuberculosis, and proper esophageal arteries （n = 16 ） and inferior phre

关 键 词：咯血 栓塞 治疗性 非支气管动脉 

分 类 号：R714.461[医药卫生—妇产科学] R562.22[医药卫生—临床医学]