| 刘 晖,姜 鹃,杨 阳,张 鑫,曹永丽.先天性支气管动脉-肺动脉瘘儿童咯血的介入治疗临床分析[J].,2019,19(11):2091-2095 |
| 先天性支气管动脉-肺动脉瘘儿童咯血的介入治疗临床分析 |
| Clinical Analysis of the Interventional Treatment for the Hemoptysis in Children with Congenital Bronchial Artery-Pulmonary Artery Fistula |
| 投稿时间：2018-12-25 修订日期：2019-01-18 |
| DOI：10.13241/j.cnki.pmb.2019.11.018 |
| 中文关键词: 先天性支气管动脉-肺动脉瘘 咯血 介入治疗 儿童 |
| 英文关键词: Congenital bronchial artery-pulmonary artery fistula Hemoptysis Interventional treatment Children |
| 基金项目:北京市科技计划项目(D131100005313014) |
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| 中文摘要: |
| 摘要 目的：总结先天性支气管动脉-肺动脉瘘患儿的临床特点及诊治经验，探讨介入治疗支气管动脉-肺动脉瘘所致咯血的安全性及有效性。方法：回顾性分析我院自2009年7月至2017年6月收治的先天性支气管动脉-肺动脉瘘所致咯血患儿36例，行支气管动脉数字减影血管造影(DSA)，选择300-700 μm聚乙烯醇(PVA)微栓颗粒或微球颗粒行支气管动脉栓塞术治疗，评价疗效，患者在术后1个月、3个月、半年、1年门诊复查。结果：多层螺旋CT血管造影(MSCTA)显示支气管动脉－肺动脉瘘直接征象的诊出率为55.5 %(20/36)，16例为假阴性(44.4 %)，未发现假阳性病例；36例患者栓塞术后治疗即刻成功率为100 %，复发率13.9 %(5/36)，复发时间出现于术后2-6个月，表现为再次咯血，但咯血量较初次封堵前减少，均行二次栓塞术。结论：介入治疗对于支气管动脉-肺动脉瘘所致咯血是一种创伤小、操作简便、疗效明确、并发症少的治疗方法。为进一步减少复发风险，患者术前应仔细进行MSCTA检查，行全面DSA下血管造影，根据患者病变血管情况选择合适的永久栓塞剂，运用恰当的栓塞技术。 |
| 英文摘要: |
| ABSTRACT Objective: To summarize the clinical characteristics, diagnosis and treatment experience of congenital bronchial artery-pulmonary artery fistula in children, and to explore the safety and effectiveness of interventional treatment for hemoptysis caused by bronchial artery-pulmonary artery fistula. Methods: 36 children with hemoptysis caused by bronchial artery-pulmonary artery fistula admitted to our hospital from July 2009 to June 2017 were retrospectively analyzed, bronchial arteriography was performed under digital subtraction angiography(DSA), bronchial arterial embolism was performed with 300-700 μm polyvinyl alcohol (PVA) microembolic par- ticles or microspheres granules. The efficacy was evaluated. The patients were reexamined at 1 month, 3 month, 6 month and 1 year af- ter operation. Results: Multislice spiral CT angiography (MSCTA) showed that diagnostic rate of direct signs of congenital bronchial artery-pulmonary artery fistula was 55.5 % (20/36), 16 cases were false negative (44.4 %) and no false positive cases were found; The im- mediate success rate was 100 % and the recurrence rate was 13.9 %(5/36) in 36 patients after embolization. The recurrence occurred 2-6 months after operation, which showed hemoptysis again, but the amount of hemoptysis was less than that before the initial occlusion, all patients underwent secondary embolization. Conclusion: Interventional treatment for hemoptysis caused by bronchial artery-pulmonary artery fistula is a minimally invasive, simple, effective and less complications treatment method. In order to further reduce the risk of re- currence, MSCTA should be performed carefully before operation, DSA angiography should be performed comprehensively, appropriate permanent embolic agents should be selected according to the patient's vascular lesions, and appropriate embolization techniques should be used. |
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