先天性支气管动脉-肺循环瘘的预防性介入栓塞治疗  

Prophylactic embolization in the treatment of congenital bronchial artery-pulmonary circulation fistulas

作　　者：黄静[1] 郑芸芸 李萍[1] 荣星[1] 张松跃[1] 夏天和[1] 仇慧仙[1] 吴蓉洲[1] HUANG Jing;ZHENG Yunyun;LI Ping;RONG Xing;ZHANG Songyue;XIA Tianhe;QIU Huixian;WU Rongzhou(Department of Pediatric Cardiovascular,the Second Affiliated Hospital&Yuying Children’s Hospital of Wenzhou Medical University,Wenzhou,325027)

机构地区：[1]温州医科大学附属第二医院育英儿童医院儿童心血管科,浙江温州325027

出　　处：《温州医科大学学报》2018年第12期921-924,928,共5页Journal of Wenzhou Medical University

基　　金：温州市公益性科技计划项目(Y20160096);浙江省自然科学基金资助项目(Y18H020057)

摘　　要：目的:探讨预防性介入栓塞治疗先天性支气管动脉-肺循环瘘(CBPF)的疗效。方法:2016年1月至2017年12月温州医科大学附属第二医院育英儿童医院收治的11例CBPF患儿(男6例,女5例),年龄11个月～12岁,均伴随动脉导管未闭(PDA),且在PDA封堵过程中经选择性支气管动脉造影确诊。针对其中10例CBPF瘘口直径大于同一水平相邻支气管动脉(提示血管扩张畸形)的患儿,分别选择不同规格可解脱带纤毛弹簧圈或pfm弹簧圈进行预防性CBPF栓塞术。术后常规进行1、3、6、12个月及此后每年1次规律随访。结果:10例患儿CBPF完全栓塞,PDA均封堵成功,封堵后降主动脉造影提示所有患儿PDA即刻完全封堵;余1例患儿因CBPF较细小并扭曲,未予完全封堵;术后随访提示所有患儿均未出现咯血等并发症。结论:预防性介入栓塞治疗CBPF安全有效,近期疗效好,但其能否有效预防大咯血仍有待后续随访。Objective:To evaluate the curative effect of the prophylactic embolization in the treatment of congenital bronchial artery-pulmonary circulation fistulas(CBPF).Methods:A total of 11 children(6 males and 5 females),who had CBPF from the Second Affiliated Hospital of Wenzhou Medical University from Jan.2016 to Dec.2017,were diagnosed with selective bronchial artery angiography in the procedure of interventional occlusion of patent ductus arteriosus(PDA).The age of all patients ranged from 11 months to 12 years old.In 10 cases,whose fistulas were larger in diameter than adjacent bronchial artery,interventional occlusion was performed by either interlock fibered coils or pfm coils.Regular follow-up was done in 1,3,6 and 12 months after operation and once a year thereafter.Results:All patients’PDA were successfully occluded.After PDA occlusion,the descending aortic angiography was applied,which showed that all 10 patients’PDA were completely closed immediately,but 1 patient was left untreated due to the tortuosity of bronchial artery.During the followup,no patient had hemoptysis or other complications.Conclusion:Prophylactic therapeutic embolization is an effective way to protect patients who have CBPF.However whether it can protect against major hemoptysis remains unknown and requires long-term follow-up.

关 键 词：支气管动脉-肺循环瘘 预防性介入栓塞 弹簧圈 

分 类 号：R320.34[医药卫生—人体解剖和组织胚胎学]