肺部体循环动脉CTA在咯血介入治疗中的应用

Bronchial and non-bronchial systemic artery CTA for interventional treatment of hemoptysis

目的 探讨肺部体循环CTA在咯血介入栓塞治疗中寻找靶血管中的应用价值。方法 将48例咯血患者根据介入栓塞术前是否行CTA检查分为CTA组（n=27）和DSA组（n=21）。CTA组术前行肺部体循环CTA检查，将重建图像传至工作站进行后处理，采用MPR、MIP和VR显示可能参与病灶区供血的动脉，根据CTA图像行DSA及介入栓塞治疗。DSA组直接行DSA及介入栓塞治疗。记录支气管动脉开口位置，比较两组术中透视时间、短期（1个月内）和长期（1个月~1年）复发率。结果 对48例咯血患者均成功栓塞。CTA组和DSA组术中透视时间分别为（31.29±6.37）min、（36.61±7.49）min，差异有统计学意义（t=－2.658，P〈0.05）。CTA组和DSA组短期复发率分别3.70%（1/27）、28.57%（6/21），差异有统计学意义（χ2=5.864，P=0.022）；长期复发率分别为7.41%（2/27）、14.29%（3/21），差异无统计学意义（χ2=0.599，P=0.379）。所有患者均未出现截瘫、皮肤局部坏死、异位栓塞等严重并发症。结论 肺部体循环CTA可准确定位支气管动脉栓塞术中的出血动脉，缩短手术时间，降低短期复发率，为介入手术方案的制定提供重要信息。

Objective To investigate the application value of the systemic pulmonary circulation artery CTA in finding the target vessels in interventional treatment of hemoptysis. Methods All of 48 patients with hemoptysis was divided into CTA group （n=27） and DSA group （n=21） according to whether underwent CTA before interventional treatment. The reconstructed images of CTA group were transmitted to the workstation for postprocessing, MPR, MIP and VR were used to display all blood supply arteries. DSA and interventional treatment were performed on the basis of the CTA images. Interventional treatment was performed directly in DSA group without CTA examination. The position of bronchial artery opening was recorded. Fluoroscopy time, short term （within 1 month） and long-term （1 month to 1 year） recurrence rate of two groups were compared. Results All 48 cases were embolized successfully. Intraoperative fluoroscopy time in CTA group and DSA group were （31.29±6.37）min and （36.61±7.49）min respectively, and there was statistically significant difference between the two groups （t=-2.658, P〈0.05）. The short-term recurrence rate was 3.70% （1/27） in CTA group and 28.57% （6/21） in DSA group, and there was statistically significant difference （χ2=5.864, P=0.022）. The long-term recurrence rate was 7.41% （2/27） in CTA group and 14.29% （3/21） in DSA group, which had no statistically significant （χ2=0.599, P=0.379）. No serious complications such as paraplegia, local skin necrosis, ectopic embolism occurred in all patients. Conclusion Preoperative systemic pulmonary artery CTA can provide accurately origin of bleeding artery for bronchial artery embolization. It can short the duration of intubation and decrease the short-term recurrence rate, and provide important information for the operation plan.