支气管动脉造影CT结合支气管镜检查诊断支气管Dieulafoy′s病(附5例报告)

Bronchial arteriography CT combined with bronchoscopy in diagnosis of Dieulafoy′s disease(a report of 5 cases)

目的探讨支气管动脉造影CT(BA-ACT)联合支气管镜检查(BS)对支气管Dieulafoy′s病(BDD)的诊断价值,以及支气管动脉栓塞(BAE)治疗BDD的作用。方法回顾性分析2008年1月至2018年1月因咯血在广州市第一人民医院或广州市胸科医院经BS疑诊、进行介入栓塞治疗的5例BDD患者的临床资料,在介入栓塞治疗手术中进行支气管动脉造影(BAG)和BA-ACT,参照BS所见对BAG旋转采集数据进行后处理,得到病变部位支气管与支气管动脉的BA-ACT重建图像。在栓塞治疗后进行BS复查和临床追踪观察,分析栓塞治疗效果。结果5例患者的BDD灶均为单个,BAG均缺乏特征性表现。BS显示BDD灶呈现为乳头状(病例1~3)、结节状(病例4)或条嵴状(病例5)支气管黏膜下隆起病灶,在BA-ACT则对应表现为支气管动脉分支局部呈"尖拱"样(病例1~4)或"串珠"样(病例5)折曲突向支气管腔。病例1~4分别进行一次BAE治疗,栓塞后BS复查显示BDD灶消隐,随访54~91个月无复发咯血。病例5的条嵴状BDD灶在BAE后BS复查显示保持形状大小不变,第一次BAE后的第71个月时复发咯血,经BAG和BA-ACT发现未塌陷的病灶由二条侧支血管供血,经再次BAE后随访71个月无复发咯血。结论BA-ACT结合BS可以对BDD进行定位定性诊断,BAE对BDD是一种非常有效的治疗方法。

Objective To investigate the diagnostic value of bronchial arteriography CT(BA-ACT)combined with bronchoscopy(BS)in bronchial Dieulafoy′s disease(BDD),and the role of bronchial artery embolization(BAE)in the treatment of BDD.Methods Retrospective analysis was made on the clinical data of 5 patients suspected of being BDD treated by BS in Guangzhou First People′s Hospital or Guangzhou Thoracic Hospital from January 2008 to January 2018 due to hemoptysis.Bronchial arteriography(BAG)and BA-ACT were performed during the operation of interventional embolization.BAG rotary acquisition data were post-processed according to BS findings,and BA-ACT reconstruction images of the diseased bronchi and bronchial arteries were obtained.BS reexamination and clinical follow-up observation were carried out after embolization to analyze the effect of embolization.Results There were one BDD lesion for the five patients respectively,and the BAG lacked characteristic manifestations.Bronchoscopy revealed BDD foci to present as papillary(case 1-case 3),nodular(case 4),or lirellate(case 5)subbronchial submucosal protrusion lesions.On the BA-ACT reconstruction plot,the BDD lesions of papillary,nodular and carination manifested correspondingly as a bronchial artery branches locally"pointed arch"shaped(cases 1-case 4)or"bead-like"(case 5)fold and protruding toward the bronchial lumen.The BDD lesions of the cases 1-case 4 retraction and disappearance after one BAE were observed by BS examination,and no hemoptysis recurrence during the follow-up period(54-91 months).The ridge like BDD lesion of the case 5 remained unchanged after BAE,and hemoptysis recurred at 71 months after the first BAE;the uncollapsed foci were supplied by two collateral vessels that confirmed by second BAG and BA-ACT,and no hemoptysis for 71 months followed up after second BAE.Conclusions BA-ACT combined with BS enables a locative and qualitative diagnosis of BDD,and BAE is a very effective treatment method for BDD.