儿童血管相关性咯血介入治疗后复发因素的分析

Analysis of pediatric hemoptysis recurrence related to vascular malformations after transcatheterocclusion

目的分析血管相关性咯血儿童介入治疗后复发的血管因素，为减少复发提供预防措施。方法回顾性分析重庆医科大学附属儿童医院心血管内科2012年6月至2017年4月27例血管相关性咯血患儿的临床资料，对复发病例的临床特点、影像学资料及治疗方案等资料进行分析和评价。结果27例咯血患儿经血管造影明确为支气管动脉-肺动脉瘘24例（88.9%）、肺动静脉瘘3例（11.1%）。23例患儿行介入封堵治疗，术后复发6例（26.1%），均为支气管动脉-肺动脉瘘，复发时间为（5.6±2.3）个月，临床资料显示复发病例均存在近期肺炎支原体感染，再次造影发现复发病例异常血管数量多走行迂曲、其他异常细小血管的增粗、堵闭血管外的相关血管出现再通。结论复发是血管相关性咯血最常见的并发症，支气管动脉-肺动脉瘘是复发最常见的异常血管类型，另外肺炎支原体感染、异常血管数量多、未堵闭血管的增粗及其他部位的血管再通是咯血复发的主要原因。

ObjectiveTo investigate pediatric hemoptysis recurrence related to vascular malformations after transcatheter occlusion and offer suitable preventive actions for reducing the rate of hemoptysis recurrence.MethodsThe clinical data of 27 children, collected form Department of Cardiology, Children′s Hospital of Chongqing Medical University between June 2012 and April 2017, with hemoptysis related to vascular malformations were retrospectively analyzed.The clinical manifestation, image feature and occlusion program of children with hemoptysis recurrence were re-analyzed and evaluated.ResultsAll 27 children with hemoptysis received transcatheter occlusion, whose vascular malformations included bronchial-pulmonary artery fistula （24 cases, 88.9%） and pulmonary arteriovenous fistulas （3 cases, 11.1%） by angiography.Six cases, approximately 26.1%, suffered from recurrent hemoptysis after therapy, and the interval time of hemoptysis recurrence was roughly （5.6±2.3）months.It indicated mycoplasma pneumonia infection in all children with hemoptysis recurrence, and re-angiography showed that more abnormal vessels were found, other minor vessels except for vessels occluded grew thick and large, vessels except for vessels occluded were recanalization in children with recurrent hemoptysis.ConclusionRecurrence is the common complication of hemoptysis related to vascular malformations in children, and bronchial-pulmonary artery fistula is the most common type with hemoptysis recurrence.The main causes of hemoptysis recurrence include mycoplasma pneumonia infection, vessels without occlusion enlargement and recanalization.