术前支气管动脉CTA在大咯血支气管动脉栓塞治疗中的临床价值  

Clinical value of preoperative bronchial artery CTA in the treatment of massive hemoptysis by arterial embolization

作　　者：屈长征 刘经武 吴廷创 柴从海 张芙蓉 田强标 Qu Changzheng;Liu Jingwu;Wu Tingchuang;Chai Conghai;Zhang Furong;Tian Qiangbiao(Department of Radiology,Zhangjiajie People's Hospital,Zhangjiajie,Hunan,427000,China)

机构地区：[1]张家界市人民医院放射科,湖南张家界427000

出　　处：《当代医学》2020年第17期32-34,共3页Contemporary Medicine

摘　　要：目的探讨术前支气管动脉CTA在大咯血支气管动脉栓塞治疗中的临床应用价值和疗效分析。方法选取张家界市人民医院2016年11月至2018年9月因咯血行支气管动脉栓塞术的75例患者,术前行支气管动脉CTA检查后介入手术的38例患者作为联合组,未行CTA检查直接介入手术的37例患者作为对照组,术后随访1年,对比两组责任动脉、非支气管动脉源性体循环动脉的检出率,栓塞术后的疗效和复发情况。结果联合组术前CTA检出责任动脉93支,其中非支气管动脉22支,术中DSA检出责任动脉126支,其中非支气管动脉46支,行CTA敏感率为73.8%(93/126),止血有效率92.11%,复发率5.26%。对照组术中检出责任动脉97支,其中非支气管动脉24支,止血有效率83.79%,复发率13.51%。联合组责任血管检出数目、非支气管动脉源性体循环动脉检出数目均优于对照组;在治疗有效率上联合组更优,且复发率明显降低;CTA检出责任血管的能力低于DSA。结论CTA能敏感发现支气管动脉及非支气管动脉源性体循环供血动脉,术前行CTA检查后再行支气管动脉造影栓塞,能明显提高责任动脉的检出率;而且疗效优于未行CTA直接介入栓塞,术后复发率降低。支气管动脉CTA在介入术前能充分了解责任血管的开口、位置、血管走行及直径,为术中快速准确寻找责任血管、超选择插管、合理选择导管提供帮助,可以缩短操作和曝光时间、缩小辐射量、减少造影剂用量,明显提高介入治疗疗效,减少复发,具有重要的临床使用及推广价值。Objective To investigate the clinical value and effect of preoperative CTA in the treatment of massive hemoptysis.Methods From November 2016 to September 2018,75 patients who underwent bronchial artery embolization due to hemoptysis in Zhangjiajie People's Hospital,38 patients who underwent interventional operation before and after CTA were treated as combined group and 37 patients who did not undergo CTA were treated as control group.They were followed up for one year,and the detection rate of responsible artery and non bronchial artery systemic circulation artery in the two groups were compared The curative effect and relapse after treatment.Results In the combined group,93 responsible arteries were detected by CTA before operation,including 22 non bronchial arteries,126 by DSA during operation,including 46 non bronchial arteries.The sensitivity rate of responsible arteries detected by CTA was 73.8%,hemostasis efficiency was 92.11%,recurrence rate was 5.26%.In the control group,97 responsible arteries were detected,including 24 non bronchial arteries.The hemostasis efficiency was 83.79%,and the recurrence rate was 13.51%.The combined group was superior to the control group in terms of the number of responsible vessels detected and the number of non bronchial artery derived systemic circulation arteries detected;the combined group was superior in the treatment efficiency,and the recurrence rate was significantly reduced,the ability of CTA to detect responsible vessels was lower than DSA.Conclusion CTA can detect bronchial artery and non bronchial artery systemic blood supply artery sensitively.Preoperative CTA and postoperative bronchial artery embolization can significantly improve the detection rate of responsible artery,the curative effect is better than that without CTA,and the recurrence rate is significantly reduced.CTA of bronchial artery can fully understand the opening,position,course and diameter of the responsible vessel before the intervention,which can provide great help for finding the responsible

关 键 词：支气管动脉CTA 大咯血 支气管动脉栓塞 临床疗效 术后复发率 

分 类 号：R56[医药卫生—呼吸系统]