大咯血合并肋间动脉-肺静脉分流的回顾性临床分析  

The retrospective clinical analysis of intercostal artery to pulmonary vein shunt with massive hemoptysis

作　　者：付志刚[1] 张晓磷[1] 韩强[1] 李海涛[1] 赵云云[1] 王俊[1] 亓小虎[1] 赵文江[1] 

机构地区：[1]三峡大学第一临床医学院宜昌市中心人民医院介入科,湖北宜昌443003

出　　处：《实用放射学杂志》2016年第1期95-98,106,共5页Journal of Practical Radiology

摘　　要：目的 探讨大咯血患者合并肋间动脉-肺静脉分流的DSA表现及血管内小颗粒性栓塞剂栓塞治疗的安全性与疗效。方法 连续收集本院大咯血住院患者104例，原发病以支气管扩张为主，约占76.0%（79/104），其次为肺结核，约占10.6%（11/104）。其中经DSA证实除支气管动脉外，肋间动脉参与供血且伴有肺静脉分流者16例，约占15.4%（16/104）。选择性插管行责任肋间动脉并手推造影，压力适中，以肺静脉早显为诊断标准。根据肺静脉显影所需的对比剂量表示分流量的大小，依据分流量大小分别使用300~500 μm PVA颗粒＋微弹簧圈或300~500 μm PVA颗粒栓塞责任血管。随访观察临床效果及并发症情况。随访1~4年。结果 所有患者成功进行责任血管栓塞，其中16例伴有肋间动脉-肺静脉分流行责任肋间动脉栓塞。责任肋间动脉共23支，其中分流量大者7支，分流量小者16支。21支成功进行责任肋间动脉末梢血管网栓塞，其中6支采用300~500 μm PVA颗粒＋微弹簧圈栓塞，15支使用300~500 μm PVA颗粒栓塞。1支由于不能超选进入肋间动脉未进行栓塞，1支肋间动脉术中形成夹层，后单纯使用微弹簧圈栓塞主干。栓塞后均有不同程度栓塞后综合征出现，经对症处理后好转，未发生脊髓动脉栓塞事件。14例患者术后咯血停止，且随访期间未见大咯血复发。1例肋间动脉未栓塞者和1例单纯肋间动脉主干栓塞者术后仍有大量咯血。结论 肋间动脉-肺静脉分流的DSA表现具有特征性，选择300~500 μm PVA颗粒或结合微弹簧圈对责任肋间动脉进行栓塞安全有效，同时预防、控制肺部感染，远期疗效满意。Objective To evaluate the safety and clinical efficacy of interventional strategies in patients with intercostal artery to pulmonary vein shunt with massive hemoptysis. Methods 104 cases with massive hemoptysis were collected continuously in our hospital. Of all these cases, 16 were diagnosed with intercostal artery to pulmonary vein fistula confirmed by DSA. Selective intubation to responsible intercostals artery was performed by push angiography with moderate pressure, and pulmonary vein imaging was consid- ered to be the early diagnosis criteria. We used contrast media close required for pulmonary vein imaging in angiography to indicate shunt volume. The application of 300--500μm PVA particles alone or 300--500μm PVA particle＋micro spring coil to responsible vessels embolism depended on shunt volume. Follow up to 1 to 4 years to monitor the clinical curative effect and complications. Resuits All patients were undergone responsible vascular embolization successfully. Of all the patients, 16 with intercostal artery to pulmonary vein shunt were undergone responsible intercostals artery embolism. There were 23 responsible intercostals arteries, 7 with large shunt volume and 16 small shunt volume included, among which 21 were embolized successfully,including 6 using 300-500μm PVA particle＋micro spring coil and 15 using 300--500μm PVA particle alone. One patient didn＇t scheduled to undergo embolotherapy due to difficulty in intubation to responsible intercostals artery and another presented dissection of intercostals artery during the surgery and had to embolize the main artery by micro spring coil. AU patients presented post-embolization syndrome to varying degrees and the condition improved without spinal embolism after symptomatic treatment. 14 patients stopped hemoptysis after the surgery and didn＇t recur during the follow-up period. Conclusion DSA manifestation of intercostal artery to pulmonary vein shunt were char-acteristic. The application of 300--500μm PVA particles with or without micro sprin

关 键 词：大咯血 肋间动脉-肺静脉分流 介入治疗 

分 类 号：R441.7[医药卫生—诊断学] R543[医药卫生—临床医学]