应用弹簧栓子栓塞治疗肺动静脉瘘

Coil embolizasion of the pulmonary artery for the therapy of pulmonary arteriovenous fistula

目的 总结应用弹簧栓子栓塞治疗肺动静脉瘘经验及疗效。方法 肺动静脉瘘 19例患者 ,其中囊状肺动静脉瘘 12例 (单发囊状 8例 ,多发囊状 4例 ) ,多发弥漫型肺小动静脉瘘 7例。均采用弹簧栓子进行栓塞治疗。结果 18例栓塞成功 ,11例囊状肺动静脉瘘股动脉平均血氧饱和度由术前 88%上升为术后 97%,7例多发弥漫型肺小动静脉瘘由术前 82 %上升为术后 93%。 1例囊状肺动静脉瘘栓塞失败 ,2例栓塞时发生一过性胸痛。 10例随诊 6个月至 9年 (平均 2 4个月 ) ,3例症状复发 ,均进行了再次栓塞治疗成功。结论 弹簧栓子栓塞治疗肺动静脉瘘 ,是安全有效的治疗方法。

Objective To examine the efficacy of coil embolization of the pulmonary artery for the therapy of pulmonary arteriovenous fistula(PAVF). Methods Ninteen patients (14 men and 5 women, 2～60 years old; mean age of 22.4 years ) with PAVF were admitted to this institute from 1986 to 1999.Angiography showed single saccular, multiple saccular and diffuse capillary pulmonary arteriovenous fistula in 8,4 and 7 patients, respectively. Stainless steel coils have been used in the treatment of PAVF. Results Embolotherapy was successful in 18 patients and failed in 1.Transcatheter treatment improved oxygenation,decreased right-to-left shunt and relieved hypoxemia symptoms. The mean arterial oxygen saturation was increased from 88% to 97% in 11 patients with saccular PAVF and from 82% to 93% in 7 patients with diffuse capillary PAVF. Air embolism through the delivery catheter, caused bradycardia and angina in 2 patients, paradoxical embolization in 1.Ten patients were followed up for 6 months to 9 years, three of them developed recanalization in 6 months, 1 year and 9 years, respectively,and then underwent successful repeat coil embolization. Conclusion Embolotherapy is an effective treatment for PAVF.