胸部增强CT在咯血患者选择性动脉栓塞术中的临床应用价值  

Clinical application value of contrast-enhanced chest CT in selective arterial embolization in patients with hemoptysis

作　　者：杨亮 姚双龙 胡世兵 徐红豆 王洵 柳昂 顾玉明 祖茂衡 徐浩 YANG Liang;YAO Shuanglong;HU Shibing;XU Hongdou;WANG Xun;LIU Ang;GU Yuming;ZU Maoheng;XU Hao(Department of Interventional Radiology,Gaochun People’s Hospital,Nanjing 211300,China;Department of Interventional Radiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu Province 221006,China)

机构地区：[1]南京市高淳人民医院介入放射科,江苏南京211300 [2]徐州医科大学附属医院介入放射科,江苏徐州221006

出　　处：《实用放射学杂志》2024年第7期1156-1159,共4页Journal of Practical Radiology

摘　　要：目的探讨胸部增强CT在选择性动脉栓塞术(SAE)前对咯血责任血管检出的临床应用价值。方法回顾性分析74例经介入治疗的咯血患者资料及术前胸部增强CT、数字减影血管造影(DSA)等资料,对责任血管造影明确后给予栓塞治疗,分析术前胸部增强CT对责任血管检出情况,对患者进行随访以观察其疗效及并发症,并分析介入疗效及复发的影响因素。结果术前胸部增强CT共检出责任血管245支,其中支气管动脉178支,异位支气管动脉10支,非支气管体循环动脉(NBSA)57支,可准确显示责任血管的解剖信息,漏诊4支肋间后动脉,诊断准确率98.4%(245/249)。所有患者术后随访12~25.6月,术后即刻止血率93.2%(69/74),有效率79.7%(59/74)。影响疗效的因素为支气管动脉-肺循环瘘、出血部位胸膜增厚、肺部基础疾病,59例有效患者中,术后复发的影响因素为肺部基础疾病。结论胸部增强CT可为咯血介入治疗提供责任血管的解剖信息,提高手术效率,降低咯血复发率。Objective To investigate the clinical application value of contrast-enhanced chest CT in the detection of responsible vessels for hemoptysis before selective arterial embolization(SAE).Methods The clinical data of 74 patients with hemoptysis treated with interventional therapy and preoperative contrast-enhanced chest CT and digital subtraction angiography(DSA)were analyzed retrospectively.The responsible vessels were identified and then embolized via angiography.The detection of the responsible vessels via preoperative contrast-enhanced chest CT was analyzed.The patients were followed up to observe the efficacy and complications,and the influencing factors of interventional efficacy and recurrence were analyzed.Results A total of 245 responsible vessels were detected by preoperative contrast-enhanced chest CT,including bronchial arteries(n=178),ectopic bronchial arteries(n=10)and non-bronchial systemic artery(NBSA)(n=57),which could accurately show the anatomical information of responsible vessels.A total of 4 posterior intercostal arteries were missed.The diagnostic accuracy was 98.4%(245/249).All patients were followed up for 12 to 25.6 months.The immediate hemostasis rate was 93.2%(69/74)and the effective rate was 79.7%(59/74),respectively.The factors affecting the efficacy were bronchial artery to pulmonary circulation fistula,pleural thickening at the bleeding site,and underlying lung disease.Among the 59 patients with effective treatment,underlying lung disease was the influencing factor for postoperative recurrence.Conclusion Contrast-enhanced chest CT can provide anatomical information about the responsible vessels for interventional therapy of hemoptysis,improving surgical efficiency and reducing the recurrence rate of hemoptysis.

关 键 词：咯血 计算机体层成像 选择性动脉栓塞术 数字减影血管造影 

分 类 号：R441.7[医药卫生—诊断学] R814.42[医药卫生—临床医学] R815