中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2009年
6期
629-633
,共5页
江森%朱晓华%孙兮文%尤正千%马骏%虞栋%彭刚%揭冰%孙春轶
江森%硃曉華%孫兮文%尤正韆%馬駿%虞棟%彭剛%揭冰%孫春軼
강삼%주효화%손혜문%우정천%마준%우동%팽강%게빙%손춘질
咯血%栓塞,治疗性%非支气管动脉
咯血%栓塞,治療性%非支氣管動脈
각혈%전새,치료성%비지기관동맥
Hemoptysis%Embolization,therapeutic%Noubronchial systemic arteries
目的 观察非支气管性体动脉(NBSA)引起咯血的发生率、与原发疾病的关系及行经导管动脉栓塞术(TAE)栓塞责任NBSA治疗咯血的效果.方法 对139例接受TAE治疗的咯血患者行系统的主动脉和锁骨下动脉造影.患者原发病为:肺结核66例(2例有胸廓改良术史、1例有肺叶切除术史、1例合并室间隔缺损),单纯性支气管扩张41例(其中1例有肺叶切除术史、1例有动脉导管未闭结扎术史),支气管肺癌15例,隐原性咯血7例,尘肺3例,支气管结石3例,支气管囊肿1例,脓胸1例,肺癌术后1例,慢性肺栓塞1例.对发现的责任NBSA行栓塞术,观察NBSA引起咯血的发生概率、责任NBSA分布情况及与原发病的关系.随访观察临床疗效和并发症.随访时间6个月至5年.结果 139例中73例(52.5%)咯血与出现病理性NBSA有关.共计181支责任NBSA,包括肋问后动脉88支、胸廓内动脉27支、膈下动脉21支、食管固动脉20支、胸外侧动脉9支、肩胛下动脉7支、肋颈干5支、甲状颈干4支.肺结核患者咯血的责任NSBA以肋间后动脉(75支)和锁骨下、腋动脉的分支(44支)为主,单纯性支气管扩张者以食管固有动脉(16支)和膈下动脉(17支)为主.本组患者TAE后,即刻止血 69例,包括1次以上支气管动脉栓塞术后支气管动脉(BA)已闭塞无效和复发的19例、BA正常的初治者4例.本组中除1例行锁骨下动脉造影术后出现同侧小脑梗死和1例行BA和胸廓内动脉栓寨术后发生呼吸衰竭外无其他严重并发症.获6个月以卜的随访60例.术后间断性痰中带血16例;11例复发,10例再次TAE后停止咯血8例、间断性痰中带血2例,1例外科肺叶切除后咯血停止;其余未再咯血,但1例术后8个月死于肿瘤进展,1例术后2周死于原呼吸衰竭加莺.结论 相邻病灶的刺激和肺血流灌注不良或缺失的心血管疾病可致相应的NBSA参与肺内供血并成为咯血的责任血管,系统的血管造影和完整的TAE可提高咯血的治疗效果.
目的 觀察非支氣管性體動脈(NBSA)引起咯血的髮生率、與原髮疾病的關繫及行經導管動脈栓塞術(TAE)栓塞責任NBSA治療咯血的效果.方法 對139例接受TAE治療的咯血患者行繫統的主動脈和鎖骨下動脈造影.患者原髮病為:肺結覈66例(2例有胸廓改良術史、1例有肺葉切除術史、1例閤併室間隔缺損),單純性支氣管擴張41例(其中1例有肺葉切除術史、1例有動脈導管未閉結扎術史),支氣管肺癌15例,隱原性咯血7例,塵肺3例,支氣管結石3例,支氣管囊腫1例,膿胸1例,肺癌術後1例,慢性肺栓塞1例.對髮現的責任NBSA行栓塞術,觀察NBSA引起咯血的髮生概率、責任NBSA分佈情況及與原髮病的關繫.隨訪觀察臨床療效和併髮癥.隨訪時間6箇月至5年.結果 139例中73例(52.5%)咯血與齣現病理性NBSA有關.共計181支責任NBSA,包括肋問後動脈88支、胸廓內動脈27支、膈下動脈21支、食管固動脈20支、胸外側動脈9支、肩胛下動脈7支、肋頸榦5支、甲狀頸榦4支.肺結覈患者咯血的責任NSBA以肋間後動脈(75支)和鎖骨下、腋動脈的分支(44支)為主,單純性支氣管擴張者以食管固有動脈(16支)和膈下動脈(17支)為主.本組患者TAE後,即刻止血 69例,包括1次以上支氣管動脈栓塞術後支氣管動脈(BA)已閉塞無效和複髮的19例、BA正常的初治者4例.本組中除1例行鎖骨下動脈造影術後齣現同側小腦梗死和1例行BA和胸廓內動脈栓寨術後髮生呼吸衰竭外無其他嚴重併髮癥.穫6箇月以蔔的隨訪60例.術後間斷性痰中帶血16例;11例複髮,10例再次TAE後停止咯血8例、間斷性痰中帶血2例,1例外科肺葉切除後咯血停止;其餘未再咯血,但1例術後8箇月死于腫瘤進展,1例術後2週死于原呼吸衰竭加鶯.結論 相鄰病竈的刺激和肺血流灌註不良或缺失的心血管疾病可緻相應的NBSA參與肺內供血併成為咯血的責任血管,繫統的血管造影和完整的TAE可提高咯血的治療效果.
목적 관찰비지기관성체동맥(NBSA)인기각혈적발생솔、여원발질병적관계급행경도관동맥전새술(TAE)전새책임NBSA치료각혈적효과.방법 대139례접수TAE치료적각혈환자행계통적주동맥화쇄골하동맥조영.환자원발병위:폐결핵66례(2례유흉곽개량술사、1례유폐협절제술사、1례합병실간격결손),단순성지기관확장41례(기중1례유폐협절제술사、1례유동맥도관미폐결찰술사),지기관폐암15례,은원성각혈7례,진폐3례,지기관결석3례,지기관낭종1례,농흉1례,폐암술후1례,만성폐전새1례.대발현적책임NBSA행전새술,관찰NBSA인기각혈적발생개솔、책임NBSA분포정황급여원발병적관계.수방관찰림상료효화병발증.수방시간6개월지5년.결과 139례중73례(52.5%)각혈여출현병이성NBSA유관.공계181지책임NBSA,포괄륵문후동맥88지、흉곽내동맥27지、격하동맥21지、식관고동맥20지、흉외측동맥9지、견갑하동맥7지、륵경간5지、갑상경간4지.폐결핵환자각혈적책임NSBA이륵간후동맥(75지)화쇄골하、액동맥적분지(44지)위주,단순성지기관확장자이식관고유동맥(16지)화격하동맥(17지)위주.본조환자TAE후,즉각지혈 69례,포괄1차이상지기관동맥전새술후지기관동맥(BA)이폐새무효화복발적19례、BA정상적초치자4례.본조중제1례행쇄골하동맥조영술후출현동측소뇌경사화1례행BA화흉곽내동맥전채술후발생호흡쇠갈외무기타엄중병발증.획6개월이복적수방60례.술후간단성담중대혈16례;11례복발,10례재차TAE후정지각혈8례、간단성담중대혈2례,1예외과폐협절제후각혈정지;기여미재각혈,단1례술후8개월사우종류진전,1례술후2주사우원호흡쇠갈가앵.결론 상린병조적자격화폐혈류관주불량혹결실적심혈관질병가치상응적NBSA삼여폐내공혈병성위각혈적책임혈관,계통적혈관조영화완정적TAE가제고각혈적치료효과.
Objective To investigate the incidence and relation to primary diseases of the nonbronchial systemic arteries (NBSA) supply to the pulmonary lesions, and to evaluate the clinical value of transcatheter arterial embolization (TAE) of the responsible NBSA for hemoptysis. Methods The aortography and subclavian artery angiography were performed in 139 patients with hemoptysis, including pulmonary tuberculosis in 66 cases (2 cases with post-thoracoplasty, 1 case with post-lobectomy, and 1 case with ventricular septal defect), bronchiectnsis in 41 ( 1 ease with post-lobectomy and 1 case with post- ligation of patent ductus arteriosus), bronchiogenic carcinoma in 15, unknown hemoptysis in 7, silicosis in 3, broncholithiasis in 3, bronchial cysts in 1, empyema in 1, postoperative lung cancer in 1, and chronic pulmonary embolism in 1, respectively. TAE was performed in patients with the discoverable responsible NBSA. The frequency, distribution and relation to primary diseases of the responsible NBSA were evaluated and the clinical results and complications were observed. Follow-up time ranged from 6 months to 5 years. Results Seventy-three patients (52. 5% ) had nonbronchial systemic contributions, including 5 cases of post-thoracotomy with pulmonary lesions, 1 case complicating with ventricular septal defect, 1 ease with post-ligation of patent ductus arterinsns, and 1 case of chronic pulmonary embolism. The total number of NBSA were 181 including posterior intercostal arteries (n = 88), internal thoracic arteries (n = 27 ), inferior phrenic arteries ( n = 21 ), proper esophageal arteries ( n = 20 ), lateral thoracic arteries ( n = 9 ), subscapular arteries ( n = 7 ), eostocervical trunks ( n = 5 ) and thyrocervical trunks ( n = 4 ) . Main responsible NBSA were posterior intercostal arteries (n = 75 ) and branches of subclavian and axillary artery (n =44) in patients with pulmonary tuberculosis, and proper esophageal arteries (n = 16 ) and inferior phrenic arteries (n = 17 ) in bronchiectasis. The clinical result was satisfactory and the bleeding ceased immediately in 69 eases including 19 cases of failed or repeated bronchial artery embolization (the arteries had been obstructive) and 4 cases of the normal bronchial arteries. No severe complications occurred except ipsilateral cerebellar infarction after subclavian artery angiography in 1 case and respiratory failure after internal thoracic artery embolization in another case. Sixty patients were followed up for more than 6 months. The result demonstrated episodic bloody sputum in 16 patients, re-bleeding in 11 and non-bleeding in another after TAE. Eight patients had non-bleeding and 2 patients had episodic bloody sputum who were re- bleeding and underwent repeated TAE. Conclusions The stimulation of adjacent lesions and the cardiovascular diseases with weakened or defected pulmonary perfusion can lead to the responsible NBSA supply to the lung in hemoptysis. During TAE for hemoptysis, the integrity angiograpby and TAE can improve the curative effect.
