弹簧圈栓塞治疗弥漫性肺动静脉瘘2例疗效观察

The observation of curative effect of spring coil embolization in the treatment of diffuse pulmonary arteriovenous fistula:report of 2 cases

目的总结使用弹簧圈血管内栓塞治疗弥漫性肺动静脉瘘的临床疗效及初步经验。方法 2例弥漫性肺动静脉瘘患者,父女关系,增强CT显示2例患者均为弥漫性肺动静脉瘘,经选择性肺动脉造影证实,并予以弹簧圈多枚对动静脉瘘进行分次选择性栓塞,成年患者先后行3次栓塞,儿童患者行2次栓塞,术中对分流量大的病灶优先进行栓塞治疗,术后1月复查血氧饱和度及血常规、术后1年行增强CT进行随访。结果手术顺利,术中再次肺动脉造影显示病灶栓塞完全,均未出现任何并发症,1个月后血氧饱和度分别由78%、75%升高至91%、86%,红细胞分别由8.17×1012/L、7.27×1012/L下降至6.63×1012/L、6.28×1012/L,血红蛋白分别由254g/L、199g/L下降至186g/L、161g/L,术后1年复查栓塞后动静脉瘘未再通,患儿发现合并脑动静脉畸形并发脑出血。结论弹簧圈血管内栓塞是治疗弥漫性肺动静脉瘘的有效方法,创伤小,近期疗效显著。

Objective To summarize the clinical curative effect and preliminary experience of using spring coil endovascular embolization in the treatment of diffuse pulmonary arteriovenous fistula （PAVF）. Methods Two patients with diffuse PAVF, with father and daughter relationship, underwent the enhanced CT. Both patients had diffuse PAVF as evidenced by CT and con- firmed by selective pulmonary artery angiography. Then, they were subjected to the divided selective embolization of arteriovenous fistula with the spring coils. Th adult patient was received 3 times of successive thrombosis embolism and the child was received 2 times of successive thrombosis embolism. The intra - operative embolization was preferred to carry out on the large quantity of shunt lesions. One month post-operation, the blood oxygen saturation and blood routine were tested and the follow-up was conduc- ted via the enhanced CT one year after surgery Results The operation was performed smoothly. The intra-operative pulmonary ar- tery angiography showed that the lesions were embolized completely. No any complications occurred, one month later, the blood oxygen saturation increased by 78% , 75% to 91%, 86% , correspondingly. The blood ceils decreased from 8.17 ×10^12/L, 7.27 ×10^12/L to 6.63×10^12/L, 6.28 ×10^12/L. The hemoglobin decreased from the 254 g/L, 199 g/L to 186 g/L, 161 g/L. One year after the operation, the re-examination showed no arteriovenous fistula. The child was found to have the cerebral venous mal- formation complicated with cerebral hemorrhage. Conclusion Intravascular embolization is an effective method for the treatment of diffuse PAVF , with less trauma and significant recent effect.