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中国防痨杂志 ›› 2021, Vol. 43 ›› Issue (7): 689-693.doi: 10.3969/j.issn.1000-6621.2021.07.009

• 论著 • 上一篇    下一篇

食管固有动脉参与肺结核大咯血供血的动脉栓塞研究

冯燕, 李颖, 李强*(), 张丹, 林虎, 郭现利   

  1. 100091 北京,解放军总医院第八医学中心呼吸与危重症医学部(冯燕、李强、张丹、林虎、郭现利); 山东省冠县人民医院东古城分院放射科(李颖)
  • 收稿日期:2021-02-07 出版日期:2021-07-10 发布日期:2021-07-09
  • 通信作者: 李强 E-mail:liqiang309@sina.com
  • 基金资助:
    首都临床特色应用研究与成果推广(Z171100001017186)

Study on arterial embolization for massive hemoptysis due to pulmonary tuberculosis when proper esophageal artery participates in blood supply

FENG Yan, LI Ying, LI Qiang*(), ZHANG Dan, LIN Hu, GUO Xian-li   

  1. *Department of Respiratory and Critical Care Medicine, the 8th Medical Center of Chinese PLA General Hospital, Beijing 100091, China
  • Received:2021-02-07 Online:2021-07-10 Published:2021-07-09
  • Contact: LI Qiang E-mail:liqiang309@sina.com

摘要: 目的 探讨有食管固有动脉参与供血的肺结核大咯血患者的病变特点,以及食管固有动脉栓塞的安全性和疗效。 方法 分析解放军总医院第八医学中心2017年6月至2020年7月收治的11例经血管造影确认有食管固有动脉参与肺结核大咯血供血患者的临床资料。患者术前行CT 扫描,术中行食管固有动脉造影,确认供血范围后将导管选择性插至动脉主干进行栓塞。选择聚乙烯醇(PVA)颗粒栓塞病变血管,分析病变分布及特点、动脉造影的表现及治疗结果。 结果 11例患者全部并发左侧纵隔胸膜增厚。并发左肺上叶毁损者3例,并发左肺下叶支气管扩张者7例,并发左肺空洞者5例。食管固有动脉开口位于胸主动脉胸椎T6水平3例,胸椎T7~8水平8例。动脉造影表现为主干增粗、分支增多、紊乱及新生血管形成。5例患者出现食管固有动脉-肺动脉分流。食管固有动脉发出吻合支与左、右支气管动脉交通各1例。治疗后所有患者咯血立即停止,3例患者分别于栓塞术后2d、22个月、37个月出现咯血复发,复发原因均与食管固有动脉无关,食管固有动脉均无再通。无严重并发症发生。 结论 食管固有动脉参与结核病变供血发生于合并左侧纵隔胸膜增厚患者,且病变多位于左肺下叶和舌叶。栓塞食管固有动脉技术上可行,安全性很高。

关键词: 结核, 肺, 咯血, 栓塞, 治疗性, 食管固有动脉, 放射摄影术, 介入性

Abstract: Objective To explore the safety and efficacy of proper esophageal artery (PEA) embolization in the treatment of massive hemoptysis due to pulmonary tuberculosis when PEA participates in blood supply, as well as the characteristics of lesions. Methods Clinical data of 11 patients confirmed that PEA participate in blood supply for the massive hemoptysis due to pulmonary tuberculosis by PEA angiography from the 8th Medical Center of Chinese PLA General Hospital between June 2017 and July 2020 were analyzed. CT scan was performed before the procedure and PEA arteriography were performed during the interventional procedure. Once the blood supply was identified, catheterization and embolization were selectively inserted into the main artery for embolization with PVA particle. The distribution and characteristics of the lesions, angiographic findings and treatment results were analyzed. Results All the 11 patients were complicated with thickening of the left mediastinal pleura. The damaged upper lobe of left lung was found in 3 patients, 7 patients were complicated with the bronchiectasis of left lower lobar, and the cavity of left lung was found in 5 patients. In 3 patients, the origin of PEA was on the level of T6; in 8 patients, the origin of PEA was on the level of T7-8. Enlargement of trunk, increase and disorder of branches, as well as neovascularization were found in angiography. PEA-pulmonary artery shunt was found in 5 patients. Communication between the esophageal artery and the left bronchial artery was observed in 1 patient, and between the esophageal artery and the right bronchial artery was observed in another patient. Hemoptysis stopped immediately after treatment in all the patients. Recurrent hemoptysis was observed in 3 patients 2 days, 22 months and 37 months after the treatment, respectively, which were considered to be unrelated to the PEA. There was no recanalization of the PEA. No serious complications were observed. Conclusion PEA participating in blood supply for tuberculosis lesion always occurred in patients complicated with thickening of the left mediastinal pleura, and lesions mainly located in the lower lobe and lingual lobe of left lung. PEA embolization is technically feasible and safe.

Key words: Tuberculosis, pulmonary, Hemoptysis, Embolization, therapeutic, Proper esophageal artery, Radiography, interventional