肺结核大咯血的营养血管分布及DSA表现

Distribution of blood vessels and DSA findings of pulmonary tuberculosis with massive hemoptysis

目的:分析肺结核大咯血的营养血管分布及血管造影表现。方法:回顾分析46例肺结核致大咯血的患者结合胸部X平片及胸部CT结果,进行胸主动脉造影、选择性支气管动脉、肋间动脉、锁骨下动脉、胸廓内动脉、胸外侧动脉、肩胛下动脉、甲状颈干等相关血管造影,在行经导管动脉栓塞术(TAE)前了解病灶的营养血管分布情况及其造影表现。结果:46例患者DSA检查中共发现102支病理性支气管动脉或病理性非支气管动脉供血,这些病理性血管均直接或者通过侧支交通形成异常血管网参与病灶供血;其中支气管动脉58支,肋间动脉22支,胸廓内动脉6支,胸外侧动脉5支,肩胛下动脉4支,甲状颈干2支,迷走支气管动脉2支,食管固有动脉1支;上述病理的血管DSA均表现为主干不同程度增粗,其远端迂曲参与病灶供血;其中DSA表现为造影剂直接外溢的50支,造影剂外溢伴动脉一肺动脉瘘或动脉一肺静脉瘘42支,通过侧支交通形成异常血管网与出血的支气管动脉或邻近动脉相通10支。结论:肺结核大咯血患者的病灶营养血管分布广泛,栓塞术前全面了解病灶供血动脉情况及血管造影表现是非常必要的,可提高止血效果及降低复发率。

Objective To analyze the distribution of blood vessels and angiography of pulmonary tuberculosis. Method Retrospective analysis of 46 cases of hemoptysis caused by pulmonary tuberculosis,We combined X chest plain film and chest CT results of patients and performed angiography on the thoracic aorta,selective bronchial artery,intercostal artery,subclavian artery,internal thoracic artery,lateral thoracic artery. Understanding the distribution of nutrient vessels and the angiographic findings before transcatheter arterial embolization（ TAE）. Results In 46 cases of DSA,we found that 102 rational bronchial arterys or pathological non bronchial arterys were involved in blood supply. These pathological vessels are involved in the blood supply of the abnormal vascular network through the collateral vessels. Among them,there were 58 branches of the bronchial artery,22 branchs of the intercostal artery of,6 branchs of the internal thoracic artery,5 branchs of the lateral thoracic artery,4 branchs of the inferior scapular artery,2 branches of cervical trunk 2 branches of the vagus nerve,and the 1 branche of the proper esophageal artery. The lesions DSA showed different degrees of arterial thickening,and distal lesions in tortuous blood. There were50 vessels of DSA showed contrast agent direct spillover,42 showed extravasation of contrast agent with artery pulmonary artery fistula or a pulmonary artery venous fistula,10 vessels are formed through the collateral traffic abnormal vascular network and bronchial artery bleeding or adjacent artery. Conclusion The distribution of the nutrient vessels in the patients with massive hemoptysis of pulmonary tuberculosis is widespread. It is necessary to fully understand the situation of blood supply artery and angiography before embolization. It can improve the hemostatic effect and reduce the recurrence rate.