隐源性咯血的介入诊断和治疗

Interventional diognosis and treatment of cryptogenic hemopotysis

探讨隐源性咯血的支气管动脉造影 (BAG)的影像表现与病理机制之间的关系 ,为其诊断和出血定位寻求可靠依据。方法 1 选择隐源性咯血病人 52例 ,包括以下两种情况 :(1)常规影像学检查阴性 (胸部平片、断层阴性 ,部分病人同期CT及支气管碘油造影阴性 ) (2 )一个肺叶或一侧肺内有少量病变 ,但BAG证实为非咯血病灶 ,而另叶或另段肺内有出血征象 ,计 17例。全部病例行Seldinger穿刺技术 ,导管经主动脉置入双侧支气管动脉造影 ,确认有造影的直接或间接出血征象 ,行双重栓塞术。 2 另选 5例术前影像学检查证实为支气管病变、BAG检查证实为出血部位和出血原因的病例 ,因栓塞止血无效或其他病变而行手术切除。对 5例手术切除标本进行病理镜下检查 ,分析其与BAG所见的相关性。结果 全部咯血病例 ,BAG均有不同程度的血管增生紊乱 ,典型者为扫帚状或网状增生、紊乱的血管束 ,严重者伴有肺内出血病灶。结合支气管扩张手术标本中的病理所见 ,如支气管周围支气管动脉的血管数增多、扭曲等 ,两者的血管改变呈一致性。结论 1 隐源性咯血的病理机制为支气管动脉损伤 ,而支气管动脉的损伤又为支气管动脉感染所致。故经BAG提示的血管异常改变可以为隐源性咯血的诊断和出血定位提供依据。 2 支气管动脉造影和栓塞集诊?

Objective To study the relationship between the image manifestation of bronchial arteriograghy (BAG) and pathologic mechanism,and quest reliable basis for its diagnosis and bleed locating.Methods 1 52 patients with cryptogenic hemoptysis were selected,including following two group:①routine image examinations (including chest plain film,tomogram,computed tomography and bronchialgraphy) were negative.②one lobe or segment showed a few lesions,but they were not the ones for causing hemoptysis proved by BAG,while another lobe or segment had signs of bleeding (17 cases).All these patients were performed by seldnger puncture technique,and catheter was put through aorta into bronchial artery.If bronchial arteriography showed direct or indirect bleeding signs,bronchial arterial embolization (BAE) was performed.2 Another 5 cases with bronchial lesions were selected,which were demonstrated by preoperative image examinations and confirmed through BAG procedures to be bleeding cause and location.They were given surgical operation because BAE were ineffective or there were other lesions.Pathological examination under microscope were conducted on these operation samples,and the correlation between BAG findings and phthologic changes was analyzed.Results For all patients with hemoptysis,their BAG showed different degree of hypervascularity,typically being broomlike or reticulate proliferation and deranging vascular bundles.Serious cases were accompanied by intrapulmonary bleeding focus.Combined the BAG findings with pathological findings from the operation samples of patients with bronchialectasis,both blood vesseles changes were identical.Conclusion 1 Pathological mechanism of cryptogenic hemoptysis is the damage of bronchial artery,which are caused by infection of bronchial artery,therefore blood vessel abnormalities indicated by BAG may provide the basis of diagnosis and bleeding locating for cryptogenic hemoptysis.2 Bronchial arteriography and embolization can integrate diagnosis with therapy,which is safte and effective,and the patients have small injuries.There is practice significance in saving the patients with massive hemoptysis.Bronchial arteriography and embolization can provide a new and effective method for controlling massive hemoptysis.