CAJ | 학술논문

目的观察咯血患者的食管固有动脉(PEA)血管造影表现,分析出现异常PEA的高危因素,评价明胶海绵(GS)栓塞PEA的安全性.方法对接受动脉栓塞治疗的43例咯血患者行选择性PEA造影术,包括肺结核15例,单纯性支气管扩张18例,结核性支气管扩张7例,支气管肺癌3例.1例1次支气管动脉栓塞术后无效.对发现异常的PEA行GS经导管内栓塞.观察选择性PEA插管的结果,分析PEA的血管造影表现.经导管补充栓塞PEA的所有患者,随访观察术中、术后的不良反应、并发症以及临床治疗效果.结果 PEA选择性插管成功37例(86.0%),共发现39支PEA.PEA表现异常17例(45.9%),血管18支(46.2%),主要表现为主干增粗、迂曲,分支增多、紊乱并进入相邻下肺组织,PEA与肺动脉分流11例,4例PEA发出1支下肺支气管动脉并与正常起源的支气管动脉异常交通2例.PEA表现异常患者中,病灶均累及肺下叶基底段,其中基础疾病以单纯性支气管扩张最多.所有患者栓塞术后均无严重并发症,临床疗效满意.结论 PEA可参与咯血的供血,当肺内病灶累及下叶基底段时,有必要行选择性PEA造影.异常的PEA应用GS经导管补充栓塞是必要和安全的.
목적 관찰각혈환자적식관고유동맥(PEA)혈관조영표현,분석출현이상PEA적고위인소,평개명효해면(GS)전새PEA적안전성.방법 대접수동맥전새치료적43례각혈환자행선택성PEA조영술,포괄폐결핵15례,단순성지기관확장18례,결핵성지기관확장7례,지기관폐암3례.1례1차지기관동맥전새술후무효.대발현이상적PEA행GS경도관내전새.관찰선택성PEA삽관적결과,분석PEA적혈관조영표현.경도관보충전새PEA적소유환자,수방관찰술중、술후적불량반응、병발증이급림상치료효과.결과 PEA선택성삽관성공37례(86.0%),공발현39지PEA.PEA표현이상17례(45.9%),혈관18지(46.2%),주요표현위주간증조、우곡,분지증다、문란병진입상린하폐조직,PEA여폐동맥분류11례,4례PEA발출1지하폐지기관동맥병여정상기원적지기관동맥이상교통2례.PEA표현이상환자중,병조균루급폐하협기저단,기중기출질병이단순성지기관확장최다.소유환자전새술후균무엄중병발증,림상료효만의.결론 PEA가삼여각혈적공혈,당폐내병조루급하협기저단시,유필요행선택성PEA조영.이상적PEA응용GS경도관보충전새시필요화안전적.
Objective To investigate the angiographic manifestation of the proper esophageal artery (PEA),the hish risk factom for the presence of the anomalous PEA in hemoptysis and to evaluate the safety of transcatheter aaefial embolization(TAE) of the PEA using gelatin sponge(GS).Methods Selective esophageal arteriography WSS performed in forty-three patients with hemoptysis,including 15 cases of pulmonary tuberculosis,18 cases of bmnchiectasis,7 cases of posttuberculous bronchiectasis and three cases of lung cancer. One case experienced failure of bronchial arterial embolization. The angiographic manifestation of the PEAs Was studied.The complications of the procedure and clinical results were observed in the patients who underwent TAE using GS.Results Thirty-nine PEAs were catheterized selectively in 37 patients(86.0%).Eighteen anomalous PEAs(46.2%)were catheterized selectively in 17 patients (45.9%).The anomalous PEAs showed tortuosity,dilatation,hyperplasia,shunting with pulmonary artery and anastomosis with the bronchial artery.All lesions involved basal segment of inferior pulmonary lobar. Bronchiectasis Was the most frequent disease for PEA abnormality. No complications occurred and satisfactory curative effect Was achieved with TAE of the anomalous PEAs.Conclusions It is necessary to perform selective proper esophageal arteriography when the lesion involves basal segment of inferior pulmonary lobar in hemoptysis.Supplemental TAE of the anomalous PEA using GS is safe and valuable in the management of hemoptysis.