大咯血介入治疗失败的罕见原因:腹腔动脉系统参与供血(附2例报告及文献复习)  

Celiac Axis Branches:a Rare Source Causing Recurrence of Hemoptysis after Embolization of Bronchial Arteries(A Report of Two Cases and Reviews of Literatures)

作　　者：施万印[1] 顾建平[1] 何旭[1] 楼文胜[1] 陈亮[1] 陈国平[1] 苏浩波[1] 宋进华[1] 汪涛[1] 赵伯翔[1] 

机构地区：[1]南京医科大学附属南京医院介入科,江苏南京210006

出　　处：《现代生物医学进展》2013年第35期6867-6871,共5页Progress in Modern Biomedicine

基　　金：江苏省卫生厅科技发展项目(KF2009151)

摘　　要：目的:咯血的主要责任血管是支气管动脉,非支气管性体动脉参与供血是大咯血介入治疗失败的重要原因,腹腔动脉系统分支动脉参与供血更为罕见。本文通过收集相关病例,结合国内外相关研究,提高对腹腔动脉系统分支动脉为咯血责任动脉的认识,探讨其可能的病理机制、危险因素。方法:回顾分析2例腹腔动脉系统分支(胃左动脉、肝左动脉)参与大咯血供血动脉的临床及影像学资料,并报道介入栓塞治疗的效果。结果:2例患者均为支气管动脉栓塞后再发大咯血,再次血管造影显示1例肝左动脉参与供血,1例胃左动脉参与供血。栓塞上述血管后,患者止血成功。病变位于下肺、伴有胸膜增厚,提示有腹腔动脉系统分支动脉参与供血的可能。术前仔细阅读患者影像学资料,术前行主动脉分支动脉CT血管成像,可减少对责任性非支气管性体动脉的遗漏。结论:腹腔动脉系统参与供血是介入栓塞治疗后咯血复发的少见原因,了解其病理机制、危险因素,及时进行栓塞,可以降低咯血的复发率。Objective： Hemoptysis commonly happens due to lesions involving bronchial artery （BA）. Even completely emboli- zing BA, recurrence of hemoptysis also happens because there have been some non-bronchial systemic arteries （NBSA） feeding lung lesions in some cases. Here we presented our cases as well as reviewed some related studies in the literatu：r, es through which we aimed to further understand celiac axis branches might be potential feeding arteries causing massive hemoptysis and to discuss the pathologic mechanism and risk factors. Methods： A retrospective analysis of the clinical and angiographic data of two patients with massive hemoptysis who were found celiac axis branches （one with left gastric artery and one with left hepatic artery） being a feeding artery causing recurrence of hemoptysis after the embolization of BA. Results： Two cases were both performed a successful embilzation of BA initially but happened recurrence of massive hemoptysis requiring a second procedure. During angiography, left hepatic artery branches in one case and left gastric artery branches in another case were found as a NBSA feeding lung lesions. After embolization these NBSA, hemoptysis was finally stopped. It was indicated that celiac axis branches might be one of the sources of hemoptysis when the lesions located at lower lung lobes with existence of thickened pleura. Careful evaluation of patients imaging data including CT angiography of aortic branches prior to interventional therapy might be a precaution against missing diagnosis of non-bronchial systemic arteries causing massive hemoptysis. Conclusion： Celiac axis branches is a rarely encountered cause of recurrence of hemoptysis after embolization of bronchial arteries. Fully familiar with its risk factors and imaging features is very helpful in preventing recurrence of hemoptysis.

关 键 词：咯血 非支气管性体动脉 腹腔干 介入治疗 

分 类 号：R441.7[医药卫生—诊断学]