的肺部出血性疾病的诊断及介入治疗VIP免费

2007年1O月第41卷第1O期ChinJRadio1．October2007．Vol41．N0．10膈下动脉参与供血的肺部出血性疾病的诊断及介入治疗王茂强刘凤永段峰宋鹏王志军王仲朴．介入放射学．【摘要】目的观察膈下动脉(IPA)参与肺部出血性疾病病灶供血的表现，评价经导管栓塞IPA的安全性和疗效。方法回顾性分析18例IPA参与肺部病变供血的肺出血性疾病患者的临床和影像资料。患者中肺部恶性肿瘤9例、支气管扩张7例、慢性炎症2例；对参与肺部病变供血的IPA进行了选择性栓塞术，栓塞剂为聚乙烯醇微球(PVA)、明胶海绵颗粒和微型钢丝圈。结果选择性IPA造影均显示IPA管径增粗、分支增多紊乱和不同程度的新生血管形成，伴有肿瘤血管和肿瘤染色者9例、IPA供血区对比剂外溢6例、IPA与肺动静脉异常交通或分流9例、非特异性片状对比剂浓染2例。18例患者的病灶均与胸膜关系密切，病变贴近膈胸膜者11例、纵隔胸膜者5例、下肺外侧胸膜者2例。本组患者均行供血IPA的栓塞术，同时栓塞胸廓内动脉7例、肋间动脉3例，术后咯血停止；随访8个月至4年，3例分别于术后1、2、6个月复发少量咯血，经保守治疗后停止；15例未再咯血。结论IPA可参与肺部出血性病变的供血，以邻近横隔和纵隔胸膜的病变多见，这是造成支气管动脉栓塞术治疗咯血失败的原因之一，行供血IPA栓塞术安全有效。【关键词】膈下动脉；血管造影术；支气管，动脉；咯血；栓塞，治疗性Inferiorphrenicarteriessupplytothepulmonaryhemorrhagiclesions：angiographicidentificationandinterventionalmanagementWANGMao—qiang，LIUFeng-yong，DUAN昭，SONG，WANGZhin，WANGZhong-pu．DepartmentoflnterventionalRadiology，theGeneralHospitalofPLA，Beijing100853，China【Abstract】ObjectiveTodescribethemanifestationsoftheinferiorphreniearteries(IPA)supplytothepulmonaryhemorrhagiclesionsandtoevaluatethesafetyandeficacyoftranscatheterarterialembolization(TAE)oftheIPA．MethodsTheclinicaldataandimagingfindingsofeishteenpatientswiththeadditionalbloodsupplytothepulmonaryhemorhagiclesionsfromtheIPAwereevaluatedretrospectively．Thecausesofthebleedingwerelungmalignanciesin9，bronchiectasisin7，andchronicinflammationin2patients．TAEsupplementallywasperformedinpatientswithIPAsupplytothepulmonarylesions，usingpolyvinylalcoholparticles，gelatinspongeparticles，andmicrocoils．ResultsSelectivearteriogramdemonstratesanenlargedIPA，withnumerousbranchesandhypervaseularityinall18cases，withtumorstainingin9，thecontrastmaterialextravasationin6，andnon—specificstainingin2cases．Inaddition．IPA—to—pulmonaryshuntingwasf0undin9cases．AllthelesionssupplyingbyIPAwereadjacenttothepleurae，includingadjacenttothediaphragmaticpleurain11，themediastinalpleurain5，andthelateralpleuraofthelowerlobein2cases．TechnicalsuccessofIPAembolizationwasachievedinthe18cases．Embolizationofothernonbronchialsystemicarteries(theinternalthoracicarteryin7andintercostalarteryin3)wasperformedatthesamesession．A1lbleedingceasedimmediatelyaftersupplementalIPAembolization．Follow—uptimerangedfrom8monthsto4years．Mildrecurrenthemoptysisoccuredin3patientsat1，2，6monthsrespectively，aftertheembolization．Thesepatientswereresponsivetoconservativemanagement．Recurentbleedingdidnotoccurin15patientsduringthefollow—up．ConclusionThepulmonaryhemorhagiclesions，especiallyadjacenttothediaphragmaticandmediastinalpleurae，canbesuppliedbyIPA，andmayresultinclinicalfailurefollowingBAE．SupplementalTAEofIPAisasafeandefectiveadjuncttoBAEinthemanagementqfbronchialbleedingsuppliedbyIPA．【Keywords】Inferiorphrenicarteries；Angiography；Arteries，bronchial；Hemoptysis；Embolization，therapeutic肺部出血性疾病(如支气管扩张、炎症性肉芽肿、肿瘤等)病变...