儿童支气管动脉肺动脉瘘的临床特征及介入手术疗效分析  

Clinical analysis and interventional assessment of bronchial pulmonary artery fistula in children:a report of 20 cases

作　　者：张继燕 刘腾 肖政辉 黄文雅 陈艳萍 张瑾 段效军 Zhang Jiyan;Liu Teng;Xiao Zhenghui;Huang Wenya;Chen Yanping;Zhang Jin;Duan Xiaojun(Department of Respiratory Medicine,Affiliated Children's Hospital,Xiangya School of Medicine,Central South University(Hunan children's hospital),Changsha 410007,China;Department of General Surgery,Hunan Chest Hospital,Changsha 410007,China;Emergency Center,Affiliated Children's Hospital,Xiangya School of Medicine,Central South University(Hunan Children's Hospital),Changsha 410007,China;Department of Vascular Intervention,Affiliated Children's Hospital,Xiangya School of Medicine,Central South University(Hunan children's hospital),Changsha 410007,China)

机构地区：[1]中南大学湘雅医学院附属儿童医院(湖南省儿童医院)呼吸内科,长沙410007 [2]湖南省胸科医院普外科,长沙410007 [3]中南大学湘雅医学院附属儿童医院(湖南省儿童医院)急救中心,长沙410007 [4]中南大学湘雅医学院附属儿童医院(湖南省儿童医院)血管介入科,长沙410007

出　　处：《临床小儿外科杂志》2024年第11期1077-1081,共5页Journal of Clinical Pediatric Surgery

基　　金：儿童急救医学湖南省重点实验室(2018TP1028);湖南省卫生健康委科研计划课题(202206013971)。

摘　　要：目的初步探讨儿童先天性支气管动脉肺动脉瘘的临床特点以及介入手术治疗效果。方法回顾性分析2016年1月至2023年8月湖南省儿童医院采取介入手术治疗的20例支气管动脉肺动脉瘘患儿临床资料,收集并分析患儿临床表现、实验室和影像学检查资料以及介入手术治疗结果。结果20例患儿中,17例表现为咯血,其中少量咯血4例、中量咯血5例、大量咯血8例;3例无咯血患儿中,1例表现为呕血,1例表现为呼吸困难,1例以胸壁肿物就诊(最终诊断为卡波西型血管瘤)。11例伴有不同程度贫血,其中轻度贫血3例、中度贫血7例、重度贫血1例。20例均行胸部增强CT检查,其中5例发现增粗、迂曲的支气管动脉。出血部位:右肺上叶1例,右肺中叶4例,右肺下叶7例,右肺中下叶混合2例,左肺下叶1例,双肺2例,3例未见明显出血病灶。20例均行数字减影血管造影(digital subtraction angiography,DSA),确诊为右侧支气管动脉肺动脉瘘19例,左侧支气管动脉肺动脉瘘1例。20例均予介入手术治疗,其中16例行首次介入治疗后随访1~4年,无一例复发,治疗效果满意;4例首次介入治疗后复发,其中3例为复发1次后行再次介入手术治疗未再复发,1例为复发5次后行第3次介入手术治疗,末次手术至今已3年6个月,暂未复发。结论咯血是支气管动脉肺动脉瘘的主要临床表现,胸部增强CT和DSA检查有助于诊断支气管动脉肺动脉瘘;介入手术疗效确切,但有一定的复发率。ObjectiveTo summarize the clinical characteristics of bronchial pulmonary artery fistula(BPAF)and evaluate the efficacy of interventional closure.MethodsFor this retrospective case study,20 children were diagnosed with bronchial pulmonary artery fistula at Hunan Children's Hospital from January 2016 to August 2023.Clinical symptoms and enhanced chest computed tomography(CT)findings were recorded.Efficacy and postoperative recurrence were evaluated.ResultsThe symptoms of hemoptysis occurred(n=17),including mild hemoptysis(n=4),moderate hemoptysis(n=5)and massive hemoptysis(n=8).Among 3 cases of non-hemoptysis,there were hematemesis(n=1),dyspnea(n=1)and Kaposi type hemangioma with"chest wall mass"(n=1).Eleven cases had varying degrees of anemia,including mild anemia(n=3),moderate anemia(n=7)and severe anemia(n=1).Enhanced chest CT revealed thickened and tortuous bronchial arteries(n=5).Digital subtraction angiography(DSA)was performed for confirming the diagnosis of right bronchial arterio-pulmonary fistula(n=19)and left bronchial arterio-pulmonary fistula(n=1).Hemorrhagic lesions were located in right upper lobe(n=1),right middle lobe(n=4)and right lower lobe(n=7),mixed right middle/lower lobe(n=2),left lower lobe(n=1)and bilateral lungs(n=2).Sixteen cases received initial interventions.During a follow-up period of 1 to 4 years,there was no recurrence.The outcomes were satisfactory;Four cases recurred after initial interventions,3 cases relapsed once and 1 case relapsing 5 times was treated thrice.The last operation was 42 months ago.There was no recurrence.ConclusionsHemoptysis is a major clinical manifestation of BPAF.Enhanced chest CT is conducive to making a definite diagnosis and DSA is a gold standard of diagnosis.Interventional therapy is both safe and effective and it has a definite efficacy with a certain recurrence rate.

关 键 词：支气管动脉 咯血 介入性 儿童 

分 类 号：R73[医药卫生—肿瘤]