肺外体循环动脉栓塞在肺结核咯血诊治中的临床意义  

Clinical significance of embolizations of nonbronchial systemic arteries for diagnosis and treatment of patients with tuberculosis and hemoptysis

作　　者：黄湘荣[1] 朱文科[1] 陆普选[1] 郑斐群[1] 李苑[1] 张丽萍[1] 郑广平[1] 余万其[1] 

机构地区：[1]深圳市第三人民医院放射科,广东518000

出　　处：《放射学实践》2011年第9期923-927,共5页Radiologic Practice

基　　金：深圳市科技计划重点项目支助(200901019)

摘　　要：目的:探讨肺外体循环动脉在肺结核咯血中的供血特点及肺外体循环动脉栓塞治疗肺结核咯血的价值,以提高介入手术治疗疗效。方法:70例肺结核咯血患者经内科治疗无效,采用Seldingers技术行股动脉穿刺,将导管插至胸主动脉和锁骨下动脉,探查病灶供血动脉,针对靶血管行栓塞治疗。结果:70例患者共行195支血管造影,有54例(77.14%,54/70)存在病灶多血供,总共179支供血血管。54例患者中支气管动脉81支,肋间后动脉74支,胸廓内动脉16支,甲状颈干4支,锁骨下动脉2支,胸外侧动脉2支。支气管及肋间后动脉共干38例,根髓动脉显示27例。一次性栓塞后即刻止血48例(82.85%,48/70);出血明显减少,经内科保守治疗1周内出血停止19例(24.29%,19/70);经2次介入手术止血3例。结论:约77%的肺结核咯血患者病灶存在多支动脉供血特点,仔细寻找肺外体循环靶血管并进行规范栓塞是提高肺结核咯血介入手术治疗疗效的有效途径。Objective：To study the blood supply features of nonbronchial systemic arteries in tuberculosis patients with hemoptysis so as to raise the effectiveness of interventional therapy.Methods：70 cases with tuberculosis with hemoptysis failed to medicine treatment.By using Seldingers technique（puncture via femoral artery）,with the tip of the catheter located in thoracic aorta and subclavian artery,the target arteries were defined by digital subtraction angiography（DSA） and embolized.Results：There were 198 arteries examined by DSA and there were multiple arterial supplies in 54 cases（in tolal 179 arteries）,accounting for 77.14%（54 /70） including 81 bronchial arteries,74 posterior intercostal arteries,16 internal thoracic arteries,4 thyrocervical trunk,2 subclavian arteries,2 lateral thoracic arteries.38 cases of bronchial arteries from intercostal artery,radiculomedullary arteries developed in 27 cases.Immediate cessation of hemoptysis in 48 of 70 cases（68.57%）;Obvious reduce of hemoptysis in 19 cases,and cessation of hemoptysis by medical treatment was achieved after one week;Interventional therapy was repeated in three cases and hemoptysis stapped.Conclusion：77% cases with hemoptysis have the features of multiple arteries supply.It is necessary to raise the efficacy of interventional therapy for patients with tuberculosis presenting hemoptysis through detecting all the feeding vessels.

关 键 词：结核 肺 咯血 栓塞 支气管动脉 放射摄影术 介入性 

分 类 号：R521[医药卫生—内科学] R815[医药卫生—临床医学]