胸廓内动脉参与肺结核大咯血供血的动脉栓塞研究  

Internal Thoracic Arterial Embolization for Massive Hemoptysis of Tuberculosis

作　　者：李颖[1,2] 李强 冯燕[1] 张丹[1] 林虎[1] 郭现利 LI Ying;LI Qiang;FENG Yan;ZHANG Dan;LIN Hu;GUO Xianli(Department of Pulmonary and Critical Care Medicine,the 8th Medical Center of Chinese PLA General Hospital,Beijing 100091,China;不详)

机构地区：[1]解放军总医院第八医学中心呼吸与危重症医学部,北京100091 [2]山东省冠县人民医院东古城分院放射科,山东冠县252500

出　　处：《中国医学影像学杂志》2021年第11期1154-1157,1164,共5页Chinese Journal of Medical Imaging

基　　金：北京市科技计划课题(Z171100001017186)。

摘　　要：目的探讨肺结核大咯血患者有胸廓内动脉(ITA)参与供血的病变特点及ITA栓塞的安全性和疗效。资料与方法对102例经血管造影确认有ITA参与肺结核大咯血供血患者进行回顾性分析,全部患者均给予动脉栓塞治疗。术前行CT扫描,术中行ITA造影,确认供血范围后将导管超选择至供血支进行栓塞,选择聚乙烯醇颗粒、微钢圈栓塞病变血管。分析病变分布及特点、动脉造影表现、术后临床经过及治疗结果。结果102例(100.0%)患者均累及两肺上叶。合并肺叶毁损28例(27.5%),合并支气管扩张37例(36.3%),合并胸膜增厚粘连或胸膜炎40例(39.2%),合并空洞63例(61.8%)。102例患者共发现119支参与供血的ITA。左侧ITA 43例,右侧ITA 42例,双侧17例。52例患者ITA发出57支异位支气管动脉。造影表现为供应病变区血管分支血管管径增粗,分支增多、紊乱及新生血管形成。均出现ITA-肺动脉异常分流道。无一例出现对比剂外溢。即刻止血成功率为100%,早期复发出血率为3.9%,平均术后出血时间(10.3±4.0)d;远期再出血率为8.8%,平均术后出血时间(19.6±12.3)个月。无严重并发症发生。结论ITA参与供血的结核病变位于肺上叶,多合并空洞、肺叶毁损、支气管扩张、胸膜增厚粘连或胸膜炎等改变。栓塞ITA技术上可行,安全性很高。Purpose To discuss the safety and efficacy of internal thoracic artery(ITA)embolization in the treatment of massive hemoptysis in patients with pulmonary tuberculosis,and to investigate the anatomic characteristics of involved ITA via CT scanning.Materials and Methods A total of 102 patients of massive hemoptysis with pulmonary tuberculosis due to the involved ITA were retrospectively selected,and all patients underwent ITA angiography embolization.CT scan was performed before the procedure and ITA arteriography were performed during the interventional procedure.The catheterization and embolization was carried out with polyvinyl alcohol particle and microcoil.After the procedure,the ITA radiological evaluation,clinical efficacy and complications were further reviewed.Results The superior lobes were involved in 102 cases(100.0%).There were 28 patients(27.5%)with damaged lobes,37 patients(36.3%)with bronchiectasis,40 patients(39.2%)with pleural thickening,63 patients(61.8%)with the cavity.Of 102 patients,a total of 119 ITA were identified as getting involved in the blood supply,including 43 patients with left ITA involved,42 patients with ITA involved,and 17 patients with bilateral ITAs involved.Of 52 patients,57 ectopic bronchial arteries were observed.The selective ITA angiography showed enlargement ITA with numberous and disordered branches and hypervascularity.ITA-pulmonary artery shunt was found in all cases.None of the cases was found extravasation of contrast medium.The rate of immediate bleeding control was 100%;the rate of short-term bleeding control was 3.9%with mean postoperative bleeding time(10.3±4.0)days,and long-term bleeding control was 8.8%with mean postoperative bleeding time(19.6±12.3)months.No major complications were observed.Conclusion The high prevalence of involved ITA could be occurred in the patients with pulmonary tuberculosis,mainly located in the superior lobes and combined with cavity,damaged lobes,bronchiectasis,pleural thickening/pleuritis,suggesting technical feasibility and safet

关 键 词：结核 肺 咯血 栓塞 治疗性 胸廓内动脉 血管造影术 放射摄影术 介入性 

分 类 号：R521[医药卫生—内科学]