摘要
目的采用^(99)Tc^m-人体大颗粒聚合白蛋白(^(99)Tc^m-MAA)肺灌注断层显像评价肺动脉血栓内膜剥脱术(PTE)对慢性血栓栓塞性肺动脉高压(CTEPH)的疗效。方法对16例CTEPH患者分别于术前、术后6~12个月行肺灌注断层显像,观察术前、术后肺叶、肺段灌注病变及改善情况,计算全肺灌注缺损百分比(PPDs%),并采用超声心动图观察术前、术后肺动脉收缩压(SPAP)的变化。结果 16例患者术后SPAP[(36.56±8.47)mmHg]较术前[(90.52±14.55)mm-Hg]明显减低(t=14.14,P<0.001)。PTE术前16例患者的96个肺叶中有86个(86/96,89.58%)存在灌注异常,术后完全改善、部分改善的肺叶分别为21个(21/86,24.42%)、65个(65/86,75.58%);术前16例患者的304个肺段中,230个(230/304,75.66%)肺段灌注异常,术后完全改善、部分改善和未改善的肺段分别为73个(73/230,31.74%)、74个(74/230,32.17%)和83个(83/230,36.09%)。术前PPDs%为(56.79±14.54)%,术后6~12个月降低为(28.20±15.24)%(t=8.13,P<0.001)。PPDs%与同期SPAP呈正相关(r=0.68,P<0.001)。结论 PTE可使CTEPH患者的SPAP明显降低,肺血流灌注明显改善,肺灌注显像可有效评价PTE疗效。
Objective To evaluate the efficacy of pulmonary thromboendarterectomy(PTE)in treatment of chronic thromboembolic pulmonary hypertension(CTEPH)using 99Tcm-macroaggregated albumin(99Tcm-MAA)pulmonary perfusion tomography.Methods Sixteen patients with CTEPH underwent 99Tcm-MAA pulmonary perfusion tomography before and 6-12 months after PTE.The perfusion defects and improvement both in pulmonary lobe and segment were observed pre-and post-PTE.Percentage of perfusion defect scores(PPDs%)were calculated and the change of systolic pulmonary artery pressure(SPAP)measured by echocardiography was also recorded.Results The postoperative SPAP was significantly lower than that before surgery([36.56±8.47]mmHg vs[90.52±14.55]mmHg,t=14.14,P0.001).Before PTE,perfusion abnormalities were identified in 86(86/96,89.58%)pulmonary lobes of 16 patients.In all of the 86 abnormal lobes,21(21/86,24.42%)became normal,and the remaining 65(65/86,75.58%)were improved after PTE.Perfusion defects were confirmed in 230(230/304,75.66%)pulmonary segments of 16 patients before surgery.In all of the 230 abnormal segments,73(73/230,31.74%)became normal,74(74/230,32.17%)were improved and 83(83/230,36.09%)remained unchanged after PTE.The mean PPDs% decreased from(56.79±14.54)% pre-PTE to(28.20±15.24)% at 6-12 months after PTE.The PPDs% was positively correlated with homochronous SPAP(r=0.68,P0.001).Conclusion PTE can significantly reduce SPAP and improve the pulmonary perfusion in CTEPH patients.Pulmonary perfusion imaging can evaluate the curative effect of PTE.
出处
《中国医学影像技术》
CSCD
北大核心
2017年第8期1148-1152,共5页
Chinese Journal of Medical Imaging Technology
关键词
高血压
肺
血栓形成
肺动脉
内膜剥脱术
肺灌注断层显像
Hypertension
pulmonary
Thrombosis
Pulmonary artery
Endarterectomy
Pulmonary perfusion tomography