经甲状颈干动脉栓塞介入治疗肺结核大咯血

Research on massive hemoptysis of tuberculosis with blood supply from thyrocervical trunk: treatment with transcatheter arterial embolization

目的:探讨甲状颈干动脉栓塞在肺咯血动脉栓塞治疗中的临床应用。方法:选取9例经内科止血治疗无效的肺结核咯血患者,在完成支气管动脉和肋间动脉造影栓塞后,对锁骨下动脉造影,发现甲状颈干动脉分支可疑参与病变供血后,对甲状颈干动脉进行超选择性插管、造影和栓塞,并观察其疗效、术后反应及并发症。结果:超选择性甲状颈干动脉造影显示,供血甲状颈干分支有不同程度扭曲、增粗、增生、扩张以及动脉与肺动脉分流。均未见明确造影剂外溢和肺静脉分流,基础病变均为慢性纤维空洞型肺结核,栓塞术后即时止血率为100%。患者术后均有中低度发热及胸背痛,仅1例发生严重疼痛,无呼吸困难、脊髓损伤及异位栓塞等并发症出现。9例患者随访期均>1年,仅1例患者动脉栓塞术后第14个月再咯血。结论:肺结核大咯血动脉栓塞治疗时应警惕甲状颈干供血,对其进行栓塞以完善治疗效果,超选择性插管后再栓塞可以保证其安全性。

Objective： To discuss the clinical application of thyrocervical trunk arterial（TTA） embolization in artery embolism for hemoptysis of tuberculosis. Methods： Nine cases of hemoptysis undertook TTA angiography and embolization after embolizing with bronchial and intercostal arteries and subclavian artery angiography. All cases were analyzed for clinical efficacy and complications. Results： Hemorrhagic TTA appeared tortuosity, dilatation, hyperplasia, aneurysm, shunt with pulmonary artery. Extravasation of contrast media and shunt with pulmonary vein were not observed. All patients had chronic fibro cavernous pulmonary tuberculosis. The postoperative immediate cessation rate of hemoptysis reached 100%. The complications occurred with fever, chest-back pain. Severe pain was observed in 1 patient. There were no spinal cord injuries and abnormal position embolization postoperatively. Among 9 cases with long follow up term more than 1 year, hemoptysis was recurred in one patient after 14 months of embolization. Conclusion： Interventional radiologist should mind TTA supply to lesions when undertaking bronchial artery embolization for hemoptysis of pulmonary tuberculosis. TTA embolization is safety and improve therapeutic efficacy in artery embolism for hemoptysis.