膈下动脉参与病灶供血的咯血介入栓塞治疗  

Endovascular treatment of inferior phrenic artery supply in hemoptysis

作　　者：严海涛 施海彬[1] 黄祥忠[2] 葛坤元[3] 刘圣[1] 卢光东[1] 祖庆泉[1] YAN Hai-tao;SHI Hai-bin;HUANG Xiang-zhong;GE Kun-yuan;LIU Sheng;LU Guang-dong;ZU Qing-quan(Department of Interventional Radiology,The First Affiliated Hospital of Nanjing Medical University,Jiangsu 210029,China)

机构地区：[1]南京医科大学第一附属医院介入放射科,江苏南京210029 [2]江阴市人民医院介入科,江苏江阴214400 [3]宜兴市人民医院介入科,江苏宜兴214200

出　　处：《影像诊断与介入放射学》2021年第3期190-194,共5页Diagnostic Imaging & Interventional Radiology

基　　金：江苏省医学重点人才基金(QNRC2016559)。

摘　　要：目的观察膈下动脉(IPA)参与的咯血患者的临床特征及预后情况,以期降低病变IPA供血的漏诊率并探究膈下动脉栓塞术治疗咯血的安全性和有效性。方法回顾性分析2015年1月~2020年6月经导管栓塞治疗的51例IPA参与供血的咯血患者临床资料、影像学及预后情况。结果本组肺部基础病包括支气管扩张40例、肺结核6例、慢性炎症3例、尘肺1例和肺癌1例。术前CTA示所有患者均存在下叶病变,48例(94.1%)胸膜增厚,47例(92.2%)存在异常IPA。术中造影共发现58条责任IPA,造影征象包括管径增粗(n=58,100%)、走行迂曲(n=55,94.8%),分支增多紊乱(n=54,93.1%)、膈下动脉-肺循环分流(n=28,48.3%)。45例(88.2%)肺部病灶由IPA和其他责任动脉共同供血,余6例责任动脉仅为IPA。所有患者均未出现严重栓塞并发症,术后1个月、1年、3年和5年的累积咯血复发率分别为5.9%、20.0%、25.9%和41.7%。结论对于肺下叶病灶伴胸膜增厚者,术前、术中充分评估IPA情况是取得介入栓塞后良好预后的重要前提。IPA栓塞咯血的治疗中是安全、有效的。Objective To assess the clinical characteristics and prognosis of patients with inferior phrenic artery(IPA)supply in hemoptysis after IPA embolization(IPAE)treatment.Methods From January 2015 to June 2020,51 patients with IPA-supplied hemoptysis were treated by endovascular IPAE.The baseline information,imaging findings,and clinical outcomes were reviewed.Results Underlying lung diseases included bronchiectasis(40),tuberculosis sequelae(6),pneumonia(3),pneumoconiosis(1),and lung cancer(1).Pre-procedure CT angiography(CTA)illustrated lower lobe lung lesions in all patients(100%),diaphragmatic pleural thickening in 48(94.1%),and abnormal IPA in 47(92.2%).Of 58 culprit IPA detected,the abnormal signs included vessel hypertrophy(58,100%),tortuosity(55,94.8%),hypervascularity(54,93.1%),and IPA-pulmonary circulation shunt(28,48.3%).Both IPA and other culprit vessels were detected in 45(88.2%)patients whereas IPA was the sole supplying vessel in 6 patients.No severe procedure-related complications occurred.Recurrent hemoptysis rates were 5.9%at 1-month,20.0%at 1-year,25.9%at 3-year,and 41.7%at 5-year follow-up.Conclusion In hemoptysis patients with hemoptysis from lower lobe lesions contacting thickened pleura,IPA should be assessed before and during embolization as prerequisite for good prognosis.IPAE is safe and effective for treatment of hemoptysis.

关 键 词：咯血 膈下动脉 介入栓塞 预后 

分 类 号：R441.7[医药卫生—诊断学]