冠状动脉与支气管动脉关系在处理咯血患者中的作用

目的 探讨冠状动脉发出异位支气管动脉和冠状动脉-支气管动脉瘘对于处理咯血患者的意义.方法 2014年4月至2021年2月行支气管动脉CTA检查的11例咯血患者中,有8例发现支气管动脉异位起源于冠状动脉,3例同时伴有冠状动脉-支气管动脉瘘,通过观察支气管动脉的轴位、多平面重建(MRP)、曲面重建(CPR)、最大密度投影(MIP)及容积重建(VR)等图像,分析其开口起源,以及对咯血的发生发展过程和对心脏可能产生的影响.结果 11例患者中,8例并发支气管扩张,4例并发肺结核,3例并发矽肺,2例并发慢性肺栓塞,11支异位支气管动脉分别起源于左侧、右侧冠状动脉,CTA可清晰显示其肺门至肺内走形,其中2例管径稍增粗,9例为正常管径,3例冠状动脉-支气管动脉瘘可见其与支气管动脉交通.结论 支气管动脉起源变异较大,而起源于冠状动脉的异位支气管动脉可能作为异常责任血管参与咯血,也可能引起冠状动脉窃血对心脏造成损害.

Objective To explore the significance of ectopic bronchial artery and coronary bronchial artery fistula in patients with hemoptysis.Methods Among the 11 cases of hemoptysis were collected from April 2014 to Febmary 2021,there were 8 parients found that the bronchial artery originated from the coronary artery,3 patients found that the bronchial artery originated from the coronary artery,and accompanied by the coronary artery branch artery fistula.By observing the axial position,multi plane reconstmction(MRP),curved surface reconstniction of the bronchial artery(CPR),maximum intensity projection(MIP)and VR(volume reconstruction)images were used to analyze the origin of the opening,and to explore the possible mechanism,as well as the possible impact on the occurrence and development of hemoptysis and the heart.Results Of the 11 cases,8 cases with bronchiectasis,4 cases with tuberculosis,3 cases with silicosis,and 2 cases with chronic pulmonary embolism.There were 11 ectopic bronchial arteries which originated from the left and right coronary arteries respectively.CTA could clearly showed the shape of hilar to intrapnlmonary branches.Among them,2 cases were slightly enlarged in diameter,9 cases were normal in diameter,and 3 cases of coronary-bronchial artery fistulas could be seen communicating with the bronchial arteries.Conclusion The origin of the bronchial artery has great variation.The ectopic bronchial artery,which originats from coronary artery,may participate in hemoptysis as an abnormal responsible vessel,and may also cause coronary steal to damage the heart.