膈下动脉参与肺结核大咯血供血的介入栓塞研究  

Inferior Phrenic Arterial Embolization for Massive Hemoptysis of Tuberculosis

作　　者：李强[1] 渠海贤 林虎[1] 谈志远[1] 敖国昆[1] 

机构地区：[1]解放军第309医院放射科,北京100091

出　　处：《中国医学影像学杂志》2015年第11期804-807,共4页Chinese Journal of Medical Imaging

基　　金：解放军总后勤部卫生部科研基金项目(BWS11J028)

摘　　要：目的支气管动脉栓塞术是大咯血患者内科治疗无效时首选的止血治疗方法,本文探讨介入栓塞膈下动脉（IPA）治疗其参与供血的肺结核大咯血的安全性和疗效。资料与方法对28例经血管造影确认有IPA参与肺结核大咯血供血患者进行栓塞。术前行CT扫描,术中行IPA造影,确认供血范围后将导管超选择至供血支进行栓塞。酌情选择明胶海绵、海藻酸钠微球、微钢圈栓塞病变血管。分析动脉造影的表现、术后临床经过及治疗结果。结果 28例患者共发现33支参与供血的IPA,左侧IPA12例,右侧IPA 11例,双侧5例。造影表现为IPA主干增粗,分支增多、紊乱及新生血管形成。22例出现IPA-肺动脉异常分流道。无一例出现对比剂外溢。4例分别于术后第2天、第6天、半年咯血复发,1例行3次治疗,3例行2次治疗。术后发热9例,胸痛19例,伴轻度呼吸困难5例,经对症治疗后多于3-7 d症状消失。结论栓塞IPA技术上可行,安全性很高,并发症少且多为自限性。Purpose Bronchial arterial embolization is the preferred hemostasis method for hemoptysis when medical treatment is invalid. This paper aims to discuss the safety and efficacy of inferior phrenic artery （IPA） embolization in the treatment of hemoptysis of tuberculosis when IPA is involved. Materials and Methods Twenty-eight patients who were confirmed that IPA got involved in the hemoptysis due to pulmonary tuberculosis by IPA angiography underwent embolization. CT scan was performed before the procedure and IPAs arteriography were performed during the interventional procedure. Once the blood supply was identified, catheterization and embolization was carried out with gelatin sponge particle, sodiurn polymannuronate microsphere or microcoil according to the patients＇ conditions. After the procedure, the IPA angiographic manifestations, clinical efficacy and complications were evaluated. Results Thirty-three IPAs were identified as getting involved in the blood supply in the 28 patients. Among those patients, 12 had lelt IPA involved, 11 had right 1PA involved and the rest 5 had IPAs involved in both sides. The selective IPA angiography showed WAs had enlargement, with numberous and disordered branches and hypervascularity, IPA-pulmonary artery shunt was found in 22 cases. None of the cases was found extravasation of contrast medium. The hemoptysis reoccurred in 4 patients on the second day, sixth day and 6 months alter the first embolization, thus the procedures were performed three times in 1 patient and twice in the other 3 patients. Nine patients had lever as complication, 19 patients had chest pain and 5 suffered from mild dyspnea. These complications usually disappeared in 3-7 days alter symptomatic treatment. Conclusion IPA embolization is technically feasible and sale, whose complications are likely to be few and self-restrictive.

关 键 词：结核 肺 咯血 栓塞 治疗性 膈下动脉 血管造影术 放射摄影术 介入性 

分 类 号：R445.2[医药卫生—影像医学与核医学]