膈下动脉参与供血的大咯血的急诊介入治疗  

Fmergency embolization therapy of massine hemoptysis sapplied by inferior phoenic arteries

作　　者：王法[1] 徐伟[1] 白彬[1] 王宏辉[1] 

机构地区：[1]哈尔滨医科大学附属第二医院介入科,黑龙江哈尔滨150086

出　　处：《医学影像学杂志》2014年第2期296-299,共4页Journal of Medical Imaging

基　　金：卫生部医药卫生科技发展研究项目(编号:W2009BX094)

摘　　要：目的探讨膈下动脉（IPA）参与供血的大咯血患者的动脉造影表现及急诊栓塞治疗的疗效。方法回顾性分析15例IPA参与供血的大咯血患者的临床资料。选用明胶海绵条、聚乙烯醇（poly vinylal cohol，PVA）颗粒及弹簧圈选择性栓塞供血的IPA，对动脉造影的表现及治疗结果进行总结及评价。结果选择性IPA造影显示为IPA增粗，分支增多、紊乱及新生血管形成。IPA供血区对比剂外溢10例，肿瘤血管及肿瘤染色3例，IPA与肺动脉分流2例。本组患者均行供血的IPA栓塞术，同时栓塞支气管动脉5支、肋间动脉4支，胸廓内动脉4支，栓塞术后咯血停止。术后随访1～2年，所有患者无再次咯血。结论IPA可参与大咯血的供血，漏栓IPA是栓塞治疗大咯血失败或复发大咯血的原因之一，行急诊IPA栓塞是一种安全、有效的治疗手段。Objective To discribe various arteriographic manifestations and to evaluate the efficacy of emergency emboli- zation of massive hemoptysis supplied by IPA. Methods The clinical data of 15 patients of massive hemoptysis supplied by inferior phrenic arteries were retrospectively analyzed. Emergency arteriography was performed for 90 patients of bron- chietasis with massive hemoptysis. IPA was embolized using embolic agents such as gelatin sponge, polyvinyl alcohol （po- ly vinyl alcohol, PVA） particles and coils. The arteriographic manifestations and effect of the treatment for massive he- moptysis were analyzed. Results Selective IPA arteriography demonstrated an enlarged IPA, numerous and disorder branches and hypervascularity were found in 15 patients. The contrast extravasations in were found 10, turnouts staining in 3, and IPA-to-pulmonary shunts in 2. The successful embolotherapy of IPA was achieved in 15 patients. Meanwhile, embolization of other feeding arteries（bronchial artery in 5; intercostal artery in 4; internal thoracic artery in 4） were per- formed. All hemoptysis ceased after IPA embolotherapy. A 1-2-year follow-up revealed that there was no recurrent he- moptysis in 15 patients. Conclusion IAP can participate in the supply of massive hemoptysis, and omission of IPA is one of the reasons of failure of hemostasis or recurrent massive hemoptysis. Emergency arterial embolization of IPA for he- moptysis is a safe and effective treatment.

关 键 词：膈下动脉 咯血 血管造影 栓塞 

分 类 号：R563[医药卫生—呼吸系统] R815[医药卫生—内科学]