肺韧带动脉参与咯血及其解剖学研究  

Massive hemoptysis from pulmonary ligament artery:Anatomic-radiologic study

作　　者：叶江卫 刘振生[2] 王稼祥[2] 王苇[2] 李澄[2] 

机构地区：[1]新疆维吾尔自治区哈密地区第二人民医院CT核磁室,哈密839000 [2]江苏省扬州市第一人民医院放射科

出　　处：《临床医学》2012年第11期13-15,共3页Clinical Medicine

摘　　要：目的观察咯血患者的异常肺韧带动脉血管造影表现,探讨异常肺韧带动脉参与咯血的高危因素。方法回顾性分析2005年1月至2011年12月间75例行支气管动脉栓塞(BAE)的大咯血患者的临床资料。所有患者术前均接受胸部CT平扫或增强扫描。观察异常肺韧带动脉的血管造影表现,分析肺韧带动脉参与咯血与病变部位、性质及纵隔胸膜受累的关系。结果 6例患者基础病变累及下肺后基底段,均无明显纵隔胸膜增厚及粘连,其中1例病变累及横膈胸膜及侧壁胸膜。此6例患者中,5例(支气管扩张)可见异常增粗、迂曲的肺韧带动脉参与供血病变肺实质,1例未见肺韧带动脉参与供血。5例肺韧带动脉参与咯血者经支气管动脉及肺韧带动脉栓塞后随访12个月未见咯血复发,其中1例病变累及侧壁胸膜及横膈胸膜者同时栓塞了参与供血的2支肋间动脉及膈下动脉。其他部位肺部病变未累及下肺后基底段者均未见肺韧带动脉参与咯血。结论当基础病变累及肺下叶后基底段时,尽管无纵隔胸膜受累,肺韧带动脉可成为咯血的重要出血来源。Objective To investigate the angiographic manifestation of the abnormal pulmonary ligament artery （PLA） and the high risk factors influencing the development of blood supply from PLA in patients with massive hemoptysis. Methods Sev- enty-five consecutive patients who underwent bronchial arterial embolization （BAE）for massive hemoptysis were evaluated between January 2005 and December 2011 retrospectively. All patients underwent enhanced or no - enhanced chest CT examination before BAE. Angiogram and CT image were analyzed to determine whether there was relationship between PLA supply and location of the underlying disease or mediastinal pleural involvement. Results The underlying lesions of 6 patients located in basal segment of the lower lobe without marked mediastinal pleural thickening and adhesion, but diaphragmatic and lateral pleural thickening in 1 case. Selective arteriogram showed enlarged and tortuous PLA and communication with bronchial artery in 5 patients. All these 5 patients were free from hemoptysis for 12 months after bronchial arteries and PLA embolization, although one of the patients re- ceived additional intercostal arteries and inferior phrenic artery embolization. No patient with massive hemoptysis whose underly- ing lesions located in other segments of lung had PLA supplying the lesion. Conclusion Ahhough there is not mediastinal pleural involvement, the underlying lesion located in basal segment of the lower lobe might indicate that PLA is the cause of bleeding in patients with massive hemoptysis.

关 键 词：咯血 肺韧带动脉 计算机断层 血管造影术 

分 类 号：R56[医药卫生—呼吸系统]