肺动静脉瘘的手术治疗

Surgical Treatment of Pulmonary Arteriovenous Malformation

我院1989至1995年共行开胸手术治疗肺动静脉瘘12例,男7例、女5例,年龄2—48岁,其中2例在妊娠发病,1例伴二尖瓣狭窄。经胸片、超声心动、声学造影及肺动脉造影诊断:7例为孤立血管瘤、3例多发血管瘤、1例单侧弥漫性肺动静脉瘘、1例肺动脉心房瘘。手术分别采用肺段切除1例、肺叶切除6例、肺叶加肺段部分切除1例、全肺切除2例、输入动脉结扎1例、肺动脉心房瘘离断1例,术后患者PaO_2明显提高,除1例术后1年死亡、1例失访外,其余患者随访2.5～8年情况良好。结合标本的病理检查,作者认为复杂动静脉瘘的实际病变范围可有较肺动脉造影显示的更广泛,传统手术切除效果更可靠。

This paper presented the result of surgical treatment for 12 patients with pulmonary arteriovenous malformation(PAVM), 7 males and 5 females,aged from 2 to 48 year,two cases out of them had their diseases during pregnancy and one had coexistent rheumatic mitral stenosis. The diagnosis was made by chest X ray film,echocardiography and pulmonary angiography. 7 cases were solitary aneurysm,3 cases were multiple ones,1 cases was diffuse pulmonary arteriovenous fistula and 1 case was pulmonary artery -left atrial communication. Six patients underwent lobetomy,1 case segmentectomy, lease lobectomy with partial resection of another lober, 2 cases pneumonectomy, 1 case ligation of afferent artery and the other had division of communication between pulmonary artery and left atrium. Post operative PaO2 were increased remarkably in all patients. All patientis have been followed up for 2. 5 to 8 years. They were in good condition except two with pneumonectomy. One died a year after discharged from the hospital and the one case lost follow-up. By examing removed lungs specimens we concluded that the actual extension of PAVM may be larger than that showed by pulmonary angiography. Then conservative surgical excision should be more effective.