肺灌注断层显像评价肺动脉血栓内膜剥脱术对慢性血栓栓塞性肺动脉高压的疗效

Evaluating efficacy of pulmonary thromboendarterectomy in treatment of chronic thromboembolic pulmonary hypertension using pulmonary perfusion tomography

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.