肺癌咯血的病因分析及介入治疗  

Etiology and interventional treatment hemoptysis in lung cancer

作　　者：张婧娴[1] 刘玉娥[1] 高峰[1] 慕伟[1] 苏泽文[1] 刘小军[1] 程晓玮 王海燕[1] 王慧[1] Zhang Jingxian;Liu Yu′e;Gao Feng;Mu Wei;Su Zewen;Liu Xiaojun;Cheng Xiaowei;Wang Haiyan;Wang Hui(Department of Intervention,Shanxi Province People′s Hospital.Taiyuan 030012,China)

机构地区：[1]山西省人民医院介入科

出　　处：《实用医学影像杂志》2019年第6期582-585,共4页Journal of Practical Medical Imaging

摘　　要：目的通过比对肺癌大咯血病例的供血动脉来源,从而分析咯血病因,栓塞责任血管,以期达到更加有效、安全的治疗效果。方法总结我院2013年1月至2017年12月,治疗的肺癌大咯血病例共25例,男性23例,女性2例,年龄48~93,平均(68±17)岁。病灶位于左肺10例,右肺15例。采用Selding′s技术穿刺股动脉、股静脉,行支气管动脉、肺外体循环动脉、肺动脉造影,确定肺癌大咯血的责任血管,选用合适的栓塞材料,对责任血管进行栓塞治疗。结果 25例肺癌大咯血患者,共造影91支血管,动脉90支,左肺动脉1支。栓塞责任血管:支气管动脉41支,内乳动脉18支,肋间动脉21支,甲状颈干4支,胸外侧动脉5支,膈下动脉1支。责任血管均为动脉,左肺动脉未见参与肺内病灶供血。5例治愈,17例显效,3例有效。其中3例患者病灶位于左肺,数字减影血管造影(DSA)见:右支气管动脉增粗并动静脉瘘,左支气管动脉未显示,未行栓塞治疗,仅行右侧支气管动脉栓塞仍然成功止血。结论肺癌咯血肿瘤并非唯一病因,可能因其他肺部病变导致。介入治疗尽可能将责任血管全部栓塞。咯血介入治疗因其创伤小,手术禁忌证少,止血迅速安全,疗效确切,目前已成为肺癌大咯血患者的首选治疗方法。Objective To By comparing the source of the feeding artery to the case of massive hemoptysis in lung cancer, the cause of hemoptysis is analyzed and the responsible blood vessels are embolized, in this way, a more effective and safe therapeutic effect can be achieved. Methods This paper summarized 25 cases of massive hemoptysis of lung cancer treated in our hospital during the four years from January 2013 to December 2017, including 23 males and 2 females, aged 48-93 with an average age of 68 years. The lesion was located in the left lung in 10 cases and the right lung in 15 cases. Selding′ s technique was used to puncture femoral artery and femoral vein, and bronchial artery, external pulmonary systemic circulation artery and pulmonary artery angiography were performed to determine the responsible vessels for massive hemoptysis of lung cancer, and appropriate embolization materials were selected to perform embolization treatment on the responsible vessels. Results In 25 patients with massive hemoptysis of lung cancer, there were 91 vessels, 90 arteries and 1 left pulmonary artery. Embolization of Responsible vessels:41 bronchial arteries, 18 internal mammary arteries, 21 intercostal arteries, 4 thyrocervical trunk, 5 lateral thoracic ar-teries, and 1 subphrenic artery. The responsible vessels were all arteries, and the left pulmonary artery was not involved in the blood supply of intrapulmonary lesions. 5 cases cure, 17 cases were markedly effective, and 3 cases were effective. Three of the patients had lesions in the left lung, DSA showed: right bronchial artery thickened with arteriovenous fistula, left bronchial artery was not shown, no embolization treatment was conducted, and right bronchial artery embolization was still successful in hemostasis. Conclusion Lung cancer hemoptysis may be caused by other lung diseases, tumor is not the only cause of it. Interventional treatment should embolize all responsible blood vessels as much as possible. The intervention treatment is a powerful measure to save the pat

关 键 词：肺肿瘤 咯血 供血动脉 介入治疗 

分 类 号：R73[医药卫生—肿瘤]