重度支气管哮喘支气管热成形术的放射学表现  

Radiographic Findings after Bronchial Thermoplasty for Severe Asthma

作　　者：林秋喜 梁燕珊 李新春[1] 曾庆思[1] 李时悦 谢佳星 张清玲 邓宇[1] LIN Qiuxi;LIANG Yanshan;LI Xinchun;ZENG Qingsi;LI Shiyue;XIE Jiaxing;ZHANG Qingling;DENG Yu(Department of Radiology,The First Hospital,Guangzhou Medical University;Department of Radiology,Panyu Hospital of Chinses Medicine;Guangzhou Institute of Respiratory Health)

机构地区：[1]广州医科大学附属第一医院放射科 [2]广州市番禺区中医院 [3]广州呼吸健康研究院

出　　处：《中国医学计算机成像杂志》2021年第5期447-452,共6页Chinese Computed Medical Imaging

基　　金：呼吸疾病国家重点实验室开放课题(SKLRD-OP-201906);广州医科大学附属第一医院2018年度成果培育和临床转化培育类项目(7)。

摘　　要：目的:探讨重度支气管哮喘支气管热成形术后的急性放射学表现及随访期改变。方法:回顾性观察2014年8月至2017年11月广州医科大学附属第一医院收治的11例经长期吸入大剂量糖皮质激素和长效β2受体激动剂后仍控制不佳的重度哮喘患者,分别经右下肺、左下肺及双上肺三次支气管热成形术治疗后,观察患者术前、术后1天内及随访的胸片,记录相应的影像学表现包括肺实变、肺不张、胸腔积液情况,以及有无并发症如气胸等。4例患者术前及术后6至12个月行CT检查,评价治疗前后胸部CT中空气潴留的程度,支气管壁增厚、黏液嵌塞的情况。结果:所有患者(100%)第一次支气管热成形术均表现为右下肺的渗出、炎症;第二次有8例(72%)表现为左下肺渗出、实变,3例(28%)为左下肺不张;第三次9例(81%)表现为双上肺内中带渗出、炎症,2例(19%)有右上肺不张。3例患者第一、二次,3例患者第二次,1例患者第一次支气管热成形术合并少量胸腔积液。所有患者支气管热成形术后1个月内复查胸片恢复正常。治疗前后胸部CT显示支气管壁增厚及黏液嵌塞无改善3例,有改善1例。结论:支气管热成形术后急性一过性放射学异常发生率高,常为靶支气管对应肺叶的肺炎及肺不张,可合并少量胸腔积液,短期内均完全吸收。CT随访显示支气管壁增厚及黏液嵌塞远期改变不明显。Purpose:To explore acute radiological abnormalities in patients with severe asthma following bronchial thermoplasty(BT)and follow-up changes.Methods:This prospective observational study included 11 patients with severe asthma diagnosed at the first affiliated hospital of Guangzhou medical university during August,2014 to November,2017,who were refractory to therapy of high dose of inhaled corticosteroids and long-acting β2 agonists.Each patient experienced three times of BT procedure respectively for the right lower lobe,the left lower lobe and both upper lobes.Chest radiography was performed before,the day after BT and at follow-up.Then all radiological abnormalities were enrolled in and evaluated including consolidation,atelectasis,pleural effusion and other complications such as pneumothorax.In order to compare extent of air trapping,thickness of bronchial wall and mucoid impaction,4 out of 11 patients performed chest CT scan before and following 6-12 months after BT.Results:All patients’lung imaging(100%)demonstrated exudation and consolidation of the right lower lobe at the first BT procedure;At second BT procedure,exudation and consolidations was shown in left lower lobe in 8 out of11(72%)and 3 cases(28%)showed the left lower lobe collapsed;9 out of 11 cases(81%)demonstrated exudation and consolidations in inner and middle zone of both upper lobe at the last BT procedure and 2 cases(19%)showed the right upper lobe collapsed.3 cases were concomitant with a little pleural effusion at the first and second BT procedure,1 case presented only at the first time and 3 cases only at the second time.All patients with radiological abnormalities showed complete recover on chest radiography.By comparing the thickness of the bronchial wall and mucoid impaction before and after procedure,three cases were with no improvement,and one case was with improvement.Conclusion:There is a high incidence rate of temporary radiological abnormalities after BT procedure.They usually manifest as consolidation and atelectasis in BT-tr

关 键 词：支气管热成形术 重度支气管哮喘 放射学 

分 类 号：R445.3[医药卫生—影像医学与核医学]